Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | RN228627 | GA |
NPI | 1023429990 |
---|---|
Provider Name | Agnes P Oyewo |
First Address | Atlanta, GA 30305 |
Second Address | Lithonia, GA 30058 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2014 |
Last Update Date | 17/05/2017 |