Healthcare Provider Details

I. General information

NPI: 1083339733
Provider Name (Legal Business Name): ATOFOM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14502 GREENVIEW DR STE 435
LAUREL MD
20708-3287
US

IV. Provider business mailing address

15711 ENSLEIGH LN
BOWIE MD
20716-3235
US

V. Phone/Fax

Practice location:
  • Phone: 301-675-9644
  • Fax: 301-804-0257
Mailing address:
  • Phone: 301-675-9644
  • Fax: 301-804-0257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TEMITOPE ADEBUSOYE
Title or Position: OWNER
Credential: NP
Phone: 301-675-9644