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1992142566 NPI number — OMOTOLA ADUKE ADEBAYO NP

NPI Number: 1992142566
Health Care Provider/Practitioner: OMOTOLA ADUKE ADEBAYO NP

Information about “1992142566” NPI (OMOTOLA ADUKE ADEBAYO NP) exists in 1992142566 in HTML format HTML  |  1992142566 in plain Text format TXT  |  1992142566 in PDF (Portable Document Format) PDF  |  1992142566 in an XML format XML  formats.

NPI Number : 1992142566 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1992142566",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ADEBAYO",
    "FirstName": "OMOTOLA",
    "MiddleName": "ADUKE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "NP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ADEBAYO",
    "OtherFirstName": "OMOTOL",
    "OtherMiddleName": "ADUKE",
    "OtherNamePrefix": "MRS.",
    "OtherNameSuffix": null,
    "OtherCredential": "NP",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "1774 BOXWOOD DR NW",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ACWORTH",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30102-3579",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "770-851-4003",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "106 RAM CAT ALY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SENECA",
    "PracticeLocationAddressStateName": "SC",
    "PracticeLocationAddressPostalCode": "29678-3244",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "864-888-4445",
    "PracticeLocationAddressFaxNumber": "864-888-4345",
    "EnumerationDate": "05/23/2013",
    "LastUpdateDate": "03/12/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363AM0700X",
          "TaxonomyName": "Medical Physician Assistant",
          "LicenseNumber": "18531",
          "LicenseNumberStateCode": "SC",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "174H00000X",
          "TaxonomyName": "Health Educator",
          "LicenseNumber": "RN",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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