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General NPI Number Information
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NPI Number | 1477806461
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Entity Type | Individual
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Provider Name | OLASUMBO OLUWAKEMI DADA
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Gender | Female
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Dates
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Enumeration Date | 10/16/2012
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | MACH 6600 VAN AALST BLVD
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City | FT. MOORE
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State | GA
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Zip | 31905
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Country | US
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Telephone | 719-231-9213
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Fax |
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Provider Business Mailing Address
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Address Line | 30 MEADOW VALLEY CT
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City | MIDLAND
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State | GA
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Zip | 31820-4393
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Country | US
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Telephone | 719-231-9213
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Fax |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN186907
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN186907
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License Number State | GA
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