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General NPI Number Information
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NPI Number | 1245715903
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Entity Type | Individual
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Provider Name | MODUPE AGBEYOMI DNP, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/28/2018
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Last Update Date | 11/29/2023
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Provider Practice Location Address
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Address Line | 13 CORPORATE BLVD NE STE 200
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City | BROOKHAVEN
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State | GA
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Zip | 30329-1900
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Country | US
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Telephone | 770-557-1079
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Fax | 770-872-6621
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Provider Business Mailing Address
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Address Line | 13 CORPORATE BLVD NE STE 200
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City | BROOKHAVEN
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State | GA
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Zip | 30329-1900
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Country | US
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Telephone | 770-557-1079
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Fax | 770-872-6621
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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 | 251F00000X
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Taxonomy Name | Home Infusion Agency
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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 | 261QI0500X
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Taxonomy Name | Infusion Therapy 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 | 261QM1000X
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Taxonomy Name | Migrant Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | F09180151
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 363LS0200X
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Taxonomy Name | School Nurse Practitioner
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License Number | F09180151
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License Number State | GA
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Taxonomy #6
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F09180151
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License Number State | GA
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