Healthcare Provider Details

I. General information

NPI: 1104287283
Provider Name (Legal Business Name): OLAWUNMI OGUN-SEMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: OLAWUNMI YETUNDE OGUN-SEMORE PMHNP-BC, ACPCNP-C

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11815 NORTHFALL LN STE 1001
ALPHARETTA GA
30009-7973
US

IV. Provider business mailing address

11815 NORTHFALL LN STE 1001
ALPHARETTA GA
30009-7973
US

V. Phone/Fax

Practice location:
  • Phone: 425-659-5073
  • Fax: 770-502-6956
Mailing address:
  • Phone: 425-659-5073
  • Fax: 770-502-6956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number182005
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN182005
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number182005
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: