Individual
FAKAYATU IBIRONKE AGBOOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
175 GWINNETT DR, LAWRENCEVILLE, GA 30046-8444
(678) 209-2396
Mailing address
2209 SWAN LAKE CT, GRAYSON, GA 30017-4222
(215) 439-2391
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2021007170
MO
Other
Enumeration date
07/27/2022
Last updated
07/27/2022
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