Healthcare Provider Details

I. General information

NPI: 1750714226
Provider Name (Legal Business Name): OMOLARA ANN OLULORO MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANN OLULORO

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 N DECATUR RD
DECATUR GA
30033-6131
US

IV. Provider business mailing address

2675 N DECATUR RD
DECATUR GA
30033-6131
US

V. Phone/Fax

Practice location:
  • Phone: 404-501-1000
  • Fax:
Mailing address:
  • Phone: 404-501-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number104755
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: