Healthcare Provider Details

I. General information

NPI: 1861040479
Provider Name (Legal Business Name): OLADUNNI FUNMI FAMINU FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 MALL RING RD STE 200
LITHONIA GA
30038-2698
US

IV. Provider business mailing address

7910 MALL RING RD STE 200
LITHONIA GA
30038-2698
US

V. Phone/Fax

Practice location:
  • Phone: 470-481-2034
  • Fax: 470-481-2577
Mailing address:
  • Phone: 470-481-2034
  • Fax: 470-481-2577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN214882
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: