Healthcare Provider Details

I. General information

NPI: 1174283386
Provider Name (Legal Business Name): TOLULOPE AROWOSEGBE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4398 ATLANTA HWY
LOGANVILLE GA
30052-7314
US

IV. Provider business mailing address

1405 BRETON HUNT LN
SUWANEE GA
30024-3871
US

V. Phone/Fax

Practice location:
  • Phone: 404-948-3019
  • Fax:
Mailing address:
  • Phone: 718-813-1462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN304428
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRN304428
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: