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General NPI Number Information
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NPI Number | 1023816220
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Entity Type | Individual
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Provider Name | OMOWUMI MARY AKINTIMEHIN-UBEKU NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 03/04/2025
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 4284 HIGHWAY 5
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-3534
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Country | US
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Telephone | 855-633-2949
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Fax | 855-225-5538
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Provider Business Mailing Address
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Address Line | 89 STALLION WAY
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City | HIRAM
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State | GA
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Zip | 30141-2347
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Country | US
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Telephone | 770-256-3578
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Fax | 855-225-5538
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN249678
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License Number State | GA
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