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NPI Code Detail

MEDICARE: OMONIYI FATAI MUTIU PMHNP

MEDICARE: OMONIYI FATAI MUTIU PMHNP
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
1163W00000XRegistered NurseRN286020GA
2363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN-NP286020GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396247359
Entity Type Code : Individual
Provider Name (Legal Business Name) : OMONIYI FATAI MUTIU PMHNP
Provider Business Mailing Address
First Line : 2055 SUGARLOAF CIR STE 575
Second Line :
City : DULUTH
State : GA
Zip : 30097-9804
Country : US
Telephone Number : 404-999-7971
Fax Number : 678-534-2045
Provider Business Practice Location Address
First Line : 2055 SUGARLOAF CIR STE 575
Second Line :
City : DULUTH
State : GA
Zip : 30097-9804
Country : US
Telephone Number : 404-999-7971
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2018
Last Update Date : 10/23/2025

Similar Medicare Providers

1376069294 — MR. DAVE MOORTHY LPC
Practice Location Address:
2055 SUGARLOAF CIR STE 575
DULUTH, GA
30097-9804
Practice Phone: 404-999-7971
Practice Fax:
1508013251 — MR. STANLEY M DORELIEN LPC
Practice Location Address:
2055 SUGARLOAF CIR STE 575
DULUTH, GA
30097-9804
Practice Phone: 404-999-7971
Practice Fax: 678-534-2045
1215345376 — KELLI MARIA GORDY LPC
Practice Location Address:
2055 SUGARLOAF CIR STE 575
DULUTH, GA
30097-9804
Practice Phone: 404-999-7971
Practice Fax: 678-534-2045
1992245591 — JAGRUTI CHAUDHARI PMHNP
Practice Location Address:
2055 SUGARLOAF CIR STE 575
DULUTH, GA
30097-9804
Practice Phone: 404-999-7971
Practice Fax: 678-534-2045
1467954537 — CHINYERE OLIVIA OKONKWO PMHNP
Practice Location Address:
2055 SUGARLOAF CIR STE 575
DULUTH, GA
30097-9804
Practice Phone: 404-999-7971
Practice Fax: 678-534-2045
1134611536 — WILLIAM G MCLEOD LPC, NCAC-II
Practice Location Address:
2055 SUGARLOAF CIR STE 575
DULUTH, GA
30097-9804
Practice Phone: 404-999-7971
Practice Fax: 678-534-2045

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