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General NPI Number Information
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NPI Number | 1669645982
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Entity Type | Individual
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Provider Name | 'TOLA O. CHARLES AKOMOLAFE DPT
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Gender | Male
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 06/02/2008
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Provider Practice Location Address
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Address Line | 101 BECKETT LN SUITE 402
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7155
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Country | US
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Telephone | 770-507-2380
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Fax |
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Provider Business Mailing Address
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Address Line | 220 EAGLES LANDING WAY
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City | MCDONOUGH
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State | GA
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Zip | 30253-8802
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Country | US
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Telephone | 770-507-2380
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT4336
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License Number State | GA
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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 | PT4336
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License Number State | GA
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