Healthcare Provider Details

I. General information

NPI: 1679075873
Provider Name (Legal Business Name): ATLANTA WIDE MOBILE TESTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 03/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 CHESHIRE BRIDGE RD NE STE C
ATLANTA GA
30324-4234
US

IV. Provider business mailing address

2215 CHESHIRE BRIDGE RD NE STE C
ATLANTA GA
30324-4234
US

V. Phone/Fax

Practice location:
  • Phone: 404-343-0088
  • Fax: 877-779-5837
Mailing address:
  • Phone: 404-343-0088
  • Fax: 877-779-5837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. OLUJIMI OLUWOLE
Title or Position: PHYSICIAN
Credential: DO
Phone: 404-343-0088