Healthcare Provider Details

I. General information

NPI: 1851289631
Provider Name (Legal Business Name): BUKOLA OGUNLEYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 GREYHOUND CT
UNION CITY GA
30291-3455
US

IV. Provider business mailing address

521 GREYHOUND CT
UNION CITY GA
30291-3455
US

V. Phone/Fax

Practice location:
  • Phone: 770-274-5992
  • Fax:
Mailing address:
  • Phone: 770-274-5991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN326429
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: