Healthcare Provider Details

I. General information

NPI: 1679921886
Provider Name (Legal Business Name): MERCY OYERINDE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MERCY EMETULU

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8170 MALL PKWY # 1362
STONECREST GA
30038-2545
US

IV. Provider business mailing address

4742 LANTERN CT
LITHONIA GA
30038-7545
US

V. Phone/Fax

Practice location:
  • Phone: 678-761-5287
  • Fax:
Mailing address:
  • Phone: 678-761-5287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN209449
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN209449
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: