Individual
OMOLOLA OTUBAGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
101 BECKETT LN, STE. 304, FAYETTEVILLE, GA 30214-7155
(770) 703-4448
(770) 703-4038
Mailing address
5465 HIGHWAY 42, 246, ELLENWOOD, GA 30294-3928
(470) 646-3738
(888) 910-6463
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN207871
GA
Other
Enumeration date
08/06/2015
Last updated
04/25/2023
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