=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083127500
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BUNMI YEMISI FOLARINDE PHD, APRN, FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2017
-----------------------------------------------------
Last Update Date | 03/13/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3616 S BOGAN RD STE 202
-----------------------------------------------------
City | BUFORD
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-333-7652
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3616 S BOGAN RD STE 202
-----------------------------------------------------
City | BUFORD
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30519-4310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-288-9740
-----------------------------------------------------
Fax | 678-288-9779
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 214997
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------