Healthcare Provider Details

I. General information

NPI: 1285483552
Provider Name (Legal Business Name): OLUFUNMILAYO DAUDU PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2024
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 WESTVIEW DR. SW PHYSICIAN ASSISTANT STUDIES MOREHOUSE SCHOOL OF MEDICIN
ATLANTA GA
30310
US

IV. Provider business mailing address

7777 FOREST LN STE C840
DALLAS TX
75230-2594
US

V. Phone/Fax

Practice location:
  • Phone: 404-756-1959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20949
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: