MEDICARE: OMOBOLA JAWO

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

General Provider Information

NPI Number	:	1982406864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OMOBOLA JAWO

Provider Business Mailing Address
First Line	:	1772 ARBOR GATE DR
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-8822
Country	:	US
Telephone Number	:	404-957-6177
Fax Number	:

Provider Business Practice Location Address
First Line	:	1772 ARBOR GATE DR
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-8822
Country	:	US
Telephone Number	:	404-957-6177
Fax Number	:

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

Provider Enumeration Date	:	03/24/2025
Last Update Date	:	03/24/2025

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Directions to “ OMOBOLA JAWO ” Practice Location

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