Healthcare Provider Details

I. General information

NPI: 1497477665
Provider Name (Legal Business Name): HELEN AGBAJE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5745 N HILLBROOKE TRCE
ALPHARETTA GA
30005-7299
US

IV. Provider business mailing address

5745 N HILLBROOKE TRCE
ALPHARETTA GA
30005-7299
US

V. Phone/Fax

Practice location:
  • Phone: 404-421-5786
  • Fax:
Mailing address:
  • Phone: 404-421-5786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN232228
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: