MEDICARE: SUNRISE PLUS LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1235969684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE PLUS LLC.

Provider Business Mailing Address
First Line	:	2649 S HILLS
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30296-6032
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2649 S HILLS
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30296-6032
Country	:	US
Telephone Number	:	404-643-7278
Fax Number	:

Authorized Official
Title or Position	:	PSYCHIATRIC MENTAL NP
Name	:	OLUWATOYIN ROTIMI
Credential	:	NURSE PRACTITIONER
Telephone Number	:	404-643-7278

Provider Enumeration Date	:	08/01/2024
Last Update Date	:	08/01/2024

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Directions to “SUNRISE PLUS LLC. ” Practice Location

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