Healthcare Provider Details

I. General information

NPI: 1548941206
Provider Name (Legal Business Name): JOY OLOYEDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 07/26/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 FOREST DR
STATESBORO GA
30458
US

IV. Provider business mailing address

5416 MAYFAIR CROSSING DR
LITHONIA GA
30038-1179
US

V. Phone/Fax

Practice location:
  • Phone: 912-478-4636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: