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General NPI Number Information
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NPI Number | 1194331439
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Entity Type | Organization
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Legal Business Name | SHITTU FAMILY PRACTICE,LLC
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Dates
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Enumeration Date | 09/22/2020
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Last Update Date | 05/17/2021
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Provider Practice Location Address
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Address Line | 213 BANKS RD
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City | FAYETTEVILLE
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State | GA
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Zip | 30214
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Country | US
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Telephone | 770-629-1917
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Fax |
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Provider Business Mailing Address
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Address Line | 213 BANKS STA
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7505
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Country | US
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Telephone | 770-629-1917
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Fax |
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Authorized Official
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Title or Position | FNP
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Name | TAWA SITOU
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Credential | NP
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Telephone | 770-629-1917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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