MEDICARE: MARYANNE ADEWAKUN

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	101YM0800X	Mental Health Counselor	008942	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	814988795	OTHER	GA	CMO

General Provider Information

NPI Number	:	1972950343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYANNE ADEWAKUN

Provider Business Mailing Address
First Line	:	4027 CHARIOT CIRCLE SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080
Country	:	US
Telephone Number	:	404-790-6527
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 LANIER AVE W STE 909
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-7641
Country	:	US
Telephone Number	:	404-790-6527
Fax Number	:	770-796-7033

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

Provider Enumeration Date	:	05/16/2016
Last Update Date	:	02/05/2026

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Directions to “ MARYANNE ADEWAKUN ” Practice Location

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