=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003771981
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OMOLAYO C AKINBOTE RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2025
-----------------------------------------------------
Last Update Date | 12/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 FLIPPEN RD
-----------------------------------------------------
City | STOCKBRIDGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30281-3537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-484-7374
-----------------------------------------------------
Fax | 678-289-6215
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 112 FLIPPEN RD
-----------------------------------------------------
City | STOCKBRIDGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30281-3537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-484-7374
-----------------------------------------------------
Fax | 678-289-6215
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number | RN146505
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------