Healthcare Provider Details

I. General information

NPI: 1851109565
Provider Name (Legal Business Name): VICTORIA AWODUNMILA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2024
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2563 MARTIN LUTHER KING JR DR SW
ATLANTA GA
30311-1715
US

IV. Provider business mailing address

225 ASTAIRE MNR
FAYETTEVILLE GA
30214-5365
US

V. Phone/Fax

Practice location:
  • Phone: 404-699-7774
  • Fax: 404-699-7716
Mailing address:
  • Phone: 972-998-1618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1018889
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: