MEDICARE: ANOFIU OWOSENI

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	251E00000X	Home Health Agency		GA

General Provider Information

NPI Number	:	1396685277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANOFIU OWOSENI

Provider Business Mailing Address
First Line	:	205 THRUSHWOOD DR
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30215-2157
Country	:	US
Telephone Number	:	631-552-7476
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 THRUSHWOOD DR
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30215-2157
Country	:	US
Telephone Number	:	631-552-7476
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2026
Last Update Date	:	03/30/2026

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