Healthcare Provider Details

I. General information

NPI: 1144653502
Provider Name (Legal Business Name): OLAYEMI AWOSANYA BELLO REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 KING AVE STE 200
ATHENS GA
30606-6710
US

IV. Provider business mailing address

2655 DANIEL PARK RUN
DACULA GA
30019-7823
US

V. Phone/Fax

Practice location:
  • Phone: 706-369-4478
  • Fax: 706-353-6639
Mailing address:
  • Phone: 920-268-5215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN266075
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number15955
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: