Healthcare Provider Details

I. General information

NPI: 1992386304
Provider Name (Legal Business Name): OLAJIDE ABIODUN OPALEYE APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4170 OLD AUSTELL RD
POWDER SPRINGS GA
30127-2691
US

IV. Provider business mailing address

5200 DALLAS HWY STE 200-134
POWDER SPRINGS GA
30127-6318
US

V. Phone/Fax

Practice location:
  • Phone: 678-521-8115
  • Fax:
Mailing address:
  • Phone: 470-593-8652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN141925
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: