Healthcare Provider Details

I. General information

NPI: 1457104655
Provider Name (Legal Business Name): OLUWATOYIN ROTIMI DNP, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2959 CHEROKEE ST NW
KENNESAW GA
30144-6521
US

IV. Provider business mailing address

2649 S HILLS
RIVERDALE GA
30296-6032
US

V. Phone/Fax

Practice location:
  • Phone: 470-531-9685
  • Fax: 949-703-7699
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN290987
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: