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Individual

OYINLOLA ABISOLA PETERSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
11 UPPER RIVERDALE RD, RIVERDALE, GA 30274
(770) 991-8199
Mailing address
5216 ROSEWOOD PL, FAIRBURN, GA 30213-5113
(678) 662-0554

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
7539
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003159740A
GA
Enumeration date
04/10/2015
Last updated
04/10/2020
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