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1457907826 NPI number — OLAWALE AGBOOLA

NPI Number: 1457907826
Health Care Provider/Practitioner: OLAWALE AGBOOLA

Information about “1457907826” NPI (OLAWALE AGBOOLA) exists in 1457907826 in HTML format HTML  |  1457907826 in plain Text format TXT  |  1457907826 in PDF (Portable Document Format) PDF  |  1457907826 in an XML format XML  formats.

NPI Number : 1457907826 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1457907826",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "AGBOOLA",
    "FirstName": "OLAWALE",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "616 MISTFLOWER DR NW",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ACWORTH",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30102-6934",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "317-319-7616",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "616 MISTFLOWER DR NW",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ACWORTH",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30102-6934",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "317-319-7616",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/12/2019",
    "LastUpdateDate": "01/08/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "103K00000X",
          "TaxonomyName": "Behavior Analyst",
          "LicenseNumber": "1-23-66558",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103K00000X",
          "TaxonomyName": "Behavior Analyst",
          "LicenseNumber": "1-23-665558",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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