Individual
IBRAHIM OMOBOLA SANNI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1053 HILL ST SE, ATLANTA, GA 30315-1903
(470) 549-3923
Mailing address
PO BOX 622, LILBURN, GA 30048-0622
(470) 549-3923
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
—
—
3747A0650X
Attendant Care Provider
—
—
376K00000X
Nurse's Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
84-5109387
IRS
—
Enumeration date
08/05/2021
Last updated
08/05/2021
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