Healthcare Provider Details

I. General information

NPI: 1497673685
Provider Name (Legal Business Name): OLUBUKOLA O KEHINDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1344 SLATE BEND DR
DACULA GA
30019-4001
US

IV. Provider business mailing address

1344 SLATE BEND DR
DACULA GA
30019-4001
US

V. Phone/Fax

Practice location:
  • Phone: 404-957-6626
  • Fax:
Mailing address:
  • Phone: 404-957-6626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number2025044629
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: