Provider Demographics
NPI:1235108176
Name:ADEBOYE, NIMOTA A (NP)
Entity type:Individual
Prefix:MRS
First Name:NIMOTA
Middle Name:A
Last Name:ADEBOYE
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:20 GLENLAKE PKWY
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3473
Mailing Address - Country:US
Mailing Address - Phone:770-677-6075
Mailing Address - Fax:770-677-7331
Practice Address - Street 1:20 GLENLAKE PKWY
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3473
Practice Address - Country:US
Practice Address - Phone:770-677-6075
Practice Address - Fax:770-677-7331
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2023-04-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN101321363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000842982BMedicaid
GA000842982BMedicaid
GA50BBGXDMedicare ID - Type Unspecified