Individual
OLUWOLE ANDREW OKUNSANYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
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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