1023747961 NPI number — DR. CHRISTOPHER OLUFEMI KOLETI DC

Table of content: DR. CHRISTOPHER OLUFEMI KOLETI DC (NPI 1023747961)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023747961 NPI number — DR. CHRISTOPHER OLUFEMI KOLETI DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOLETI
Provider First Name:
CHRISTOPHER
Provider Middle Name:
OLUFEMI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023747961
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5485 NORTHCUT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30349-6172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-713-8996
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4306 N PEACHTREE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30341-1369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-395-7646
Provider Business Practice Location Address Fax Number:
678-395-7856
Provider Enumeration Date:
06/07/2022

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: 111N00000X , with the licence number:  CHIR010775 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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