=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023429990
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AGNES PUKANDE OYEWO FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2014
-----------------------------------------------------
Last Update Date | 10/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 235 CENTRAL AVE SW
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30303-3642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-546-4731
-----------------------------------------------------
Fax | 678-610-6025
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3495 PIEDMONT RD NE
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30305-1717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-504-5678
-----------------------------------------------------
Fax | 678-610-6025
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | RN228627
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------