Individual
AYODELE ADEGUNWA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
250 BRAY STREET, ATHENS, GA 30601-2244
(706) 389-6767
Mailing address
2526 BRIAR VALLEY WAY, DACULA, GA 30019-7515
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
26NP05001700
NJ
164W00000X
Licensed Practical Nurse
Primary
LPN071336
GA
Other
Enumeration date
05/12/2020
Last updated
05/12/2020
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