MEDICARE: OLADUNNI FUNMI FAMINU FNP

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	363LF0000X	Family Nurse Practitioner	RN214882	GA

General Provider Information

NPI Number	:	1861040479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLADUNNI FUNMI FAMINU FNP

Provider Business Mailing Address
First Line	:	2701 N DECATUR RD # 2400
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-5918
Country	:	US
Telephone Number	:	770-617-7493
Fax Number	:

Provider Business Practice Location Address
First Line	:	275 CARPENTER DR STE 310
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-4911
Country	:	US
Telephone Number	:	844-403-4325
Fax Number	:

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

Provider Enumeration Date	:	08/27/2019
Last Update Date	:	10/07/2021

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