Healthcare Provider Details

I. General information

NPI: 1013614668
Provider Name (Legal Business Name): OYEBISI MORILIAT KILANI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 MITCHELL BRIDGE RD
ATHENS GA
30606-2043
US

IV. Provider business mailing address

2857 TREESIDE TER
MARIETTA GA
30066-1115
US

V. Phone/Fax

Practice location:
  • Phone: 770-910-9196
  • Fax: 770-910-9196
Mailing address:
  • Phone: 470-272-5945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberRN296953
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN296953
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: