Omolola Otubaga
Nurse Practitioner - Psychiatric/Mental Health
101 Beckett Ln Ste. 304
Fayetteville
, Georgia 30214-7155
Omolola Otubaga
Nurse Practitioner - Psychiatric/Mental Health
101 Beckett Ln Ste. 304
Fayetteville
, Georgia 30214-7155
(404) 444-1904
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About
Features
Specialties
- Nurse Practitioner - Psychiatric/Mental Health
Languages spoken
- English
Location
First Address
- Omolola Otubaga
- 5465 Highway 42 246
- Ellenwood, GA
- Zip : 30294-3928
- Phone : (404) 444-1904
Second Address
- Omolola Otubaga
- 101 Beckett Ln Ste. 304
- Fayetteville, GA
- Zip : 30214-7155
- Fax : (770) 703-4038
- Phone : (770) 703-4448
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | RN207871 | GA |
National Provider Identifier
| NPI | 1033595566 |
|---|---|
| Provider Name | Omolola Otubaga |
| First Address | Ellenwood, GA 30294-3928 |
| Second Address | Fayetteville, GA 30214-7155 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 06/08/2015 |
| Last Update Date | 06/08/2015 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.