Individual
OMOLARA B KUTEYI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3546 COVINGTON HWY, STE C, DECATUR, GA 30032-1823
(404) 284-7744
(404) 284-8006
Mailing address
1262 EMMA JEAN PL SW, MARIETTA, GA 30064-3798
(404) 284-7744
(404) 284-8006
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
053776
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
053776
PHYSICIAN LICENSE
GA
01
—
10040207
AMERIGROUP
GA
01
—
200819
BLUE CROSS BLUE SHIELD
GA
01
—
319682
WELLCARE
GA
01
—
774394819B
PEACHSTATE
GA
05
—
774394819C
—
GA
05
—
774394819D
—
GA
01
—
P00183443
RAILROAD
GA
Enumeration date
04/17/2006
Last updated
12/07/2011
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