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General NPI Number Information
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NPI Number | 1194245894
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Entity Type | Individual
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Provider Name | YUSUF ABIODUN OPAKUNLE DPM
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Gender | Male
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Dates
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Enumeration Date | 06/23/2017
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Last Update Date | 10/07/2020
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Provider Practice Location Address
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Address Line | 600 PROFESSIONAL DR STE 130
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-7638
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Country | US
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Telephone | 770-255-0434
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Fax | 770-255-0433
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Provider Business Mailing Address
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Address Line | 600 PROFESSIONAL DR STE 130
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-7638
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Country | US
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Telephone | 770-255-0434
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Fax | 770-255-0433
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 682
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | POD001345
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License Number State | GA
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