Healthcare Provider Details

I. General information

NPI: 1184210536
Provider Name (Legal Business Name): SEYI AMOSU, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 06/23/2024
Certification Date: 06/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 E PONCE DE LEON AVE STE 220
DECATUR GA
30030-3452
US

IV. Provider business mailing address

235 E PONCE DE LEON AVE STE 220
DECATUR GA
30030-3452
US

V. Phone/Fax

Practice location:
  • Phone: 678-799-7576
  • Fax: 678-799-7576
Mailing address:
  • Phone: 678-799-7576
  • Fax: 678-799-7576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: DR. OLUWASEYI OLOLADE AMOSU
Title or Position: OWNER
Credential: PHD
Phone: 678-799-7576