Healthcare Provider Details

I. General information

NPI: 1508488800
Provider Name (Legal Business Name): 3 PLE O LLPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 DALE ST
RED BOILING SPRINGS TN
37150-2102
US

IV. Provider business mailing address

209 COLLEGE ST
LAFAYETTE TN
37083-1701
US

V. Phone/Fax

Practice location:
  • Phone: 615-699-3169
  • Fax:
Mailing address:
  • Phone: 615-406-8891
  • Fax: 615-666-3488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: OLUFEMI ODUNUSI
Title or Position: CEO
Credential: MD
Phone: 615-406-8891