1063743375 NPI number — MS. OYINLOLA AJOKE WINFUNLE MFT

Table of content: MS. OYINLOLA AJOKE WINFUNLE MFT (NPI 1063743375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063743375 NPI number — MS. OYINLOLA AJOKE WINFUNLE MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WINFUNLE
Provider First Name:
OYINLOLA
Provider Middle Name:
AJOKE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAWSON
Provider Other First Name:
OYINLOLA
Provider Other Middle Name:
AJOKE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063743375
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
145 LAUGHLIN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOCUST GROVE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30248-6012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-320-7501
Provider Business Mailing Address Fax Number:
770-320-7501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 LAUGHLIN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOCUST GROVE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30248-6012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-320-7501
Provider Business Practice Location Address Fax Number:
770-320-7501
Provider Enumeration Date:
01/26/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com