Organization
AGAPE SPORTS PERFORMANCE WELLNESS AND REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TOLA O C AKOMOLAFE DPT MS CCI CEAS (CEO)
(770) 839-0841
Entity
Organization
Contact information
Practice address
402 BECKETT LANE, FAYETTEVILLE, GA 30214
(404) 839-0841
Mailing address
220 EAGLES LANDING WAY, MCDONOUGH, GA 30253-8802
(404) 839-0841
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT 04336
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
166964592
NPPES/NPI
GA
Enumeration date
06/16/2008
Last updated
06/16/2008
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