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General NPI Number Information
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NPI Number | 1780112789
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Entity Type | Individual
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Provider Name | MARY TEMILOLA ABDUL RN-BC, MSN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/02/2017
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 939 BOB ARNOLD BLVD STE A&F
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City | LITHIA SPRINGS
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State | GA
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Zip | 30122-3258
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Country | US
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Telephone | 770-769-1724
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Fax |
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Provider Business Mailing Address
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Address Line | 2258 TRIPLE CROWN LN
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City | LITHONIA
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State | GA
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Zip | 30058-2101
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Country | US
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Telephone | 646-880-7317
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Fax | 516-542-5556
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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 | F341113-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN301836
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License Number State | GA
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