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MODUPE AGBEYOMI FNP

Family >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1245715903

Individual Registrant:
 MODUPE  AGBEYOMI FNP
Gender: F
Sole Proprietor

Location and contact information for practice:
2703 TRIP HOLLOW WAY  GRAYSON, GA 30017-7846 US
Tel: 678-772-3422  Fax: --

Contact information for business:
2703 TRIP HOLLOW WAY  GRAYSON, GA 30017-7846 US
Tel: --  Fax: --

Registration Information:
NPI: 1245715903
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LF0000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Family
GAF09180151

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
F09180151GA05




HEALTH CARE JOBS GA - Page 1



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