Healthcare Provider Details

I. General information

NPI: 1558162727
Provider Name (Legal Business Name): OLALEKAN OLORUNYOMI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2025
Last Update Date: 03/22/2025
Certification Date: 03/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 DULUTH HWY STE 501
LAWRENCEVILLE GA
30046-8709
US

IV. Provider business mailing address

3515 PLEASANTDALE RD APT 322
DORAVILLE GA
30340-5692
US

V. Phone/Fax

Practice location:
  • Phone: 678-312-0400
  • Fax:
Mailing address:
  • Phone: 404-399-1327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: