Healthcare Provider Details

I. General information

NPI: 1407761893
Provider Name (Legal Business Name): LTOA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 EASLEY DR
LAWRENCEVILLE GA
30045-3567
US

IV. Provider business mailing address

403 EASLEY DR
LAWRENCEVILLE GA
30045-3567
US

V. Phone/Fax

Practice location:
  • Phone: 404-488-7654
  • Fax:
Mailing address:
  • Phone: 404-488-7654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHIKODI OLAYINKA
Title or Position: OWNER
Credential:
Phone: 214-432-6794