Healthcare Provider Details

I. General information

NPI: 1437945995
Provider Name (Legal Business Name): TOLANI LYNAT OLATUNJI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2591 CANDLER RD
DECATUR GA
30032-6502
US

IV. Provider business mailing address

581 SLEW DR
CANTON GA
30115-3102
US

V. Phone/Fax

Practice location:
  • Phone: 678-209-2710
  • Fax:
Mailing address:
  • Phone: 224-518-4028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN303630
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: