Individual
OLUWOLE ANDREW OKUNSANYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
743 SPRING ST NE, GAINESVILLE, GA 30501-3715
(770) 219-9000
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
004091
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52126587
BLUE CROSS BLUE SHIELD
GA
01
—
582632608
TRICARE
GA
Enumeration date
08/14/2006
Last updated
05/15/2024
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