1780604389 NPI number — SYLVERIA OLUWATOSIN OLATIDOYE MD

Table of content: SYLVERIA OLUWATOSIN OLATIDOYE MD (NPI 1780604389)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780604389 NPI number — SYLVERIA OLUWATOSIN OLATIDOYE MD

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
OLATIDOYE

Provider First Name:
SYLVERIA

Provider Middle Name:
OLUWATOSIN

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:
MD

Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:
MUNIS

Provider Other First Name:
SYLVERIA

Provider Other Middle Name:
OLUWATOSIN

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:
MD

Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780604389

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
02/08/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3495 PIEDMONT RD NE

Provider Second Line Business Mailing Address:
BLD NINE

Provider Business Mailing Address City Name:
ATLANTA

Provider Business Mailing Address State Name:
GA

Provider Business Mailing Address Postal Code:
30305-1773

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
404-364-7000

Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1125 TOWNE CENTRE VILLAGE DRIVE

Provider Second Line Business Practice Location Address:
KAISER PERMANENTE HENRY MEDICAL CENTER

Provider Business Practice Location Address City Name:
MCDONOUGH

Provider Business Practice Location Address State Name:
GA

Provider Business Practice Location Address Postal Code:
30253

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
678-583-6579

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:
07/20/2006

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: 207Q00000X , with the licence number: 048687 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .