Omolara Kuteyi Md, Inc | |
3546 Covington Hwy Suite C Decatur GA 30032-1823 | |
(404) 284-7744 | |
(404) 284-8006 |
Full Name | Omolara Kuteyi Md, Inc |
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Speciality | Family Medicine |
Location | 3546 Covington Hwy, Decatur, Georgia |
Authorized Official Name and Position | Omolara B Kuteyi (OWNER) |
Authorized Official Contact | 4042847744 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Omolara Kuteyi Md, Inc 1262 Emma Jean Pl Sw Marietta GA 30064-3798 Ph: (404) 284-7744 | Omolara Kuteyi Md, Inc 3546 Covington Hwy Suite C Decatur GA 30032-1823 Ph: (404) 284-7744 |
NPI Number | 1235343088 |
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Provider Enumeration Date | 05/10/2007 |
Last Update Date | 12/07/2011 |
Medicare PECOS PAC ID | 2961545637 |
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Medicare Enrollment ID | O20100203000215 |
Identifier | Type | State | Issuer |
---|---|---|---|
1235343088 | NPI | - | NPPES |
053776 | Other | GA | LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 053776 (Georgia) | Primary |
Provider Name | Omolara B Kuteyi |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1780648568 PECOS PAC ID: 4183601529 Enrollment ID: I20040702000424 |
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