Olivia T Agboola
Nurse Practitioner, Family in Mcdonough, GA. Individual provider (NPI-1).
NPI number1568022671
StatusActive
Last updated in NPPESJun 20, 2019
Details
- NPI
- 1568022671
- Entity type
- Individual (NPI-1)
- Name
- Olivia T Agboola
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jun 20, 2019
- Last updated
- Jun 20, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | RN209875 | GA | Yes |
Practice location
135 Henry PkwyMcdonough, GA 30253-6636
Phone 770-288-6155 · Fax 770-954-2269
Mailing address
4001 S River LnEllenwood, GA 30294-3293
Phone 678-357-6069
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