Healthcare Provider Details

I. General information

NPI: 1467915173
Provider Name (Legal Business Name): MOSUNMOLUWA OYENUGA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 WELLBROOK CIR NE STE 103
CONYERS GA
30012-3825
US

IV. Provider business mailing address

1365 CLIFTON RD NE BLDG B
ATLANTA GA
30322-1013
US

V. Phone/Fax

Practice location:
  • Phone: 770-918-2320
  • Fax:
Mailing address:
  • Phone: 404-712-1722
  • Fax: 404-251-1899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number70938
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number15383
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: