OMOLOLA OTUBAGA (NPI# 1033595566) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033595566 |
| Entity Type | Individual |
| Full Name | OMOLOLA OTUBAGA |
| Credential | NP |
| Practice Address |
101 Beckett Ln Ste. 304 Fayetteville GA 30214-7155 |
| Mailing Address |
5465 Highway 42 246 Ellenwood GA 30294-3928 |
| Practice Telephone | 7707034448 |
| Practice Fax Number | 7707034038 |
| Mailing Telephone | 4044441904 |
| Enumeration Date | 2015-08-06 |
| Last Update Date | 2015-08-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
RN207871 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
101 BECKETT LN STE. 304 |
| City | FAYETTEVILLE |
| State | GA |
| Zip Code | 30214-7155 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083668271 | Salih O Faldon | Emergency Medicine | 101 Beckett Ln, 506, Fayetteville, GA 30214-7155 | 2006-05-20 |
| 1821461484 | Children 1st Pediatrics | Clinic/Center | 101 Beckett Ln, Suite 502, Fayetteville, GA 30214-7155 | 2015-11-04 |
| 1699146738 | Turning Point Counseling Services, LLC | Counselor | 101 Beckett Ln, Suite 505, Fayetteville, GA 30214-7155 | 2015-10-15 |
| 1467858068 | Augusta Abbey | Secured Medical Transport (VAN) | 101 Beckett Ln, Suite 505, Fayetteville, GA 30214-7155 | 2014-11-08 |
| 1649549775 | Md 1 Care | Clinic/Center | 101 Beckett Ln, Suite 506, Fayetteville, GA 30214-7155 | 2011-12-19 |
| 1164702288 | God's In Control Transportation Services | Non-emergency Medical Transport (VAN) | 101 Beckett Ln, Suite 505, Fayetteville, GA 30214-7155 | 2011-08-20 |
| 1508155037 | Easy Walk Foot Clinic LLC | Podiatrist | 101 Beckett Ln, Suite 104, Fayetteville, GA 30214-7155 | 2011-04-05 |
| 1710284369 | Provider Resource Solutions of Georgia Inc | Foster Care Agency | 101 Beckett Ln, Suite 505, Fayetteville, GA 30214-7155 | 2011-02-17 |
| 1417251810 | Provider Resource Solutions of Georgia, Inc | Day Training, Developmentally Disabled Services | 101 Beckett Ln, Suite 505, Fayetteville, GA 30214-7155 | 2010-12-29 |
| 1205145414 | Provider Resource Solutions LLC | Supports Brokerage | 101 Beckett Ln, Fayetteville, GA 30214-7155 | 2010-10-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548872468 | Phyllis Kelly Wood | Nurse Practitioner | 217 Banks Rd, Suite 31, Fayetteville, GA 30214 | 2020-08-21 |
| 1073139317 | Tyisha Salter Scott | Counselor | 110 Habersham Drive, Suite 142, Fayetteville, GA 30214 | 2020-06-23 |
| 1194341412 | Camille Franncine Bolton | Physical Therapist | 500 Floy Farr Parkway, Suite 303, Fayetteville, GA 30214 | 2020-06-23 |
| 1205465895 | Gillian Vaughan Heard | Physician Assistant | 1275 Ga-54 #201, Fayetteville, GA 30214 | 2020-04-06 |
| 1881234557 | Peach Fits,inc | Mastectomy Fitter | 285 Glynn Street South, Suites 102 and 104, Fayetteville, GA 30214 | 2020-01-10 |
| 1255981072 | Delta Healthcare Providers | Clinic/Center | 1275 W Lanier Ave, #200, Fayetteville, GA 30214 | 2019-09-13 |
| 1861965592 | Hierarchy for Wellness | Specialist | 805 S Glynn St Bldg 127 142, Fayetteville, GA 30214 | 2019-01-04 |
| 1356810634 | Fayette Dental Group PC | Clinic/Center | 720 W Lanier Ave, Fayetteville, GA 30214 | 2018-11-16 |
| 1891263299 | Mattie Mae Farmer Clark | Specialist/Technologist, Other | Piedmont Fayette Hospital, 1255 Highway 54 West, Fayetteville, GA 30214 | 2018-11-05 |
| 1093293607 | Allyson Holland | Pharmacist | 880 Highway 85 South, Fayetteville, GA 30214 | 2018-08-06 |
| Find all providers in zip 30214 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477189157 | Fatimat Olumayowa Olufunmilayo Agbojeyin | Nurse Practitioner | 105 Emerald Lake Ct, Fayetteville, GA 30215-7748 | 2020-03-13 |
| 1548821069 | Asic Behavioral Health, Pllc | Nurse Practitioner | 6977 Nexus Ct Ste 103, Fayetteville, NC 28304-2651 | 2019-06-25 |
| 1245794387 | Stacey Lasandra Mitchell | Nurse Practitioner | 1415 Highway 85 N Ste 310-390, Fayetteville, GA 30214-7738 | 2019-01-23 |
| 1417206491 | Casey J Scott | Nurse Practitioner | 4001 Cumberland Rd, Fayetteville, NC 28306-6703 | 2012-09-05 |
| 1972510519 | Melodie W. Stembridge | Nurse Practitioner | 1100 No. College Avenue, Vhsa, Fayetteville, AR 72703 | 2006-08-02 |
| 1053313536 | Margaret Jean Davis | Nurse Practitioner | 4276 Legend Avenue, Fayetteville, NC 28303-3497 | 2005-08-15 |
| 1811517469 | Ifeoma Nnani | Nurse Practitioner | 2300 Ramsey St, Fayetteville, NC 28301-3856 | 2020-04-23 |
| 1497380414 | Andrew Eisele | Nurse Practitioner | 1955 W Truckers Dr, Fayetteville, AR 72704-5637 | 2020-03-10 |
| 1417582545 | Latoya Harley-dowden | Nurse Practitioner | 806 Hay St, Fayetteville, NC 28305-5312 | 2020-03-09 |
| 1104459114 | Stephanie Bohannon | Nurse Practitioner | 112 W Center St Ste 201, Fayetteville, AR 72701-6073 | 2020-02-18 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 30214 |
Please comment or provide details below to improve the information on OMOLOLA OTUBAGA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.