Individual provider · NPI-1

Dr. Modupe Agbeyomi, DNP, FNP-C

Nurse Practitioner, Family · Brookhaven, GA

NPI number1245715903

StatusActive

Last updated in NPPESNov 29, 2023

Details

NPI: 1245715903
Entity type: Individual (NPI-1)
Name: Dr. Modupe Agbeyomi
Credential: DNP, FNP-C
Sex: Female
Sole proprietor: Yes
Enumeration date: Sep 28, 2018
Certification date: Nov 29, 2023
Last updated: Nov 29, 2023

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
363LF0000X	Nurse Practitioner, Family	F09180151	GA	Yes
251F00000X	Home Infusion	–	–
261QI0500X	Clinic/Center, Infusion Therapy	–	–
261QM1000X	Clinic/Center, Migrant Health	–	–
363LP2300X	Nurse Practitioner, Primary Care	F09180151	GA
363LS0200X	Nurse Practitioner, School	F09180151	GA

Practice location

13 Corporate Blvd Ne Ste 200
Brookhaven, GA 30329-1900

Phone 770-557-1079 · Fax 770-872-6621

Mailing address

13 Corporate Blvd Ne Ste 200
Brookhaven, GA 30329-1900

Phone 770-557-1079 · Fax 770-872-6621

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