Healthcare Provider Details

I. General information

NPI: 1619831542
Provider Name (Legal Business Name): ADENIKE ENIGBOKAN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 MOSSY BRANCH DR
SNELLVILLE GA
30078-7779
US

IV. Provider business mailing address

2515 MOSSY BRANCH DR
SNELLVILLE GA
30078-7779
US

V. Phone/Fax

Practice location:
  • Phone: 470-485-2996
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: