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General NPI Number Information
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NPI Number | 1649931452
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Entity Type | Individual
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Provider Name | OLUBUSOLA IDOWU-OGUNDIPE NP-C
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Gender | Female
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Dates
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Enumeration Date | 01/04/2022
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Last Update Date | 08/25/2022
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Provider Practice Location Address
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Address Line | 250 MARTIN LUTHER KING JR BLVD
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City | MACON
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State | GA
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Zip | 31201-3490
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Country | US
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Telephone | 478-301-4111
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Fax | 478-301-2272
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Provider Business Mailing Address
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Address Line | 250 MARTIN LUTHER KING JR BLVD
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City | MACON
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State | GA
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Zip | 31201-3490
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Country | US
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Telephone | 478-301-2123
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Fax | 478-301-2272
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN229160
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License Number State | GA
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