| Shittu Family Practice,llc | |
|
213 Banks Rd Fayetteville GA 30214 | |
| (770) 629-1917 | |
| Not Available |
| Full Name | Shittu Family Practice,llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 213 Banks Rd, Fayetteville, Georgia |
| Authorized Official Name and Position | Tawa Sitou (FNP) |
| Authorized Official Contact | 7706291917 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shittu Family Practice,llc 213 Banks Sta Fayetteville GA 30214-7505 Ph: (770) 629-1917 | Shittu Family Practice,llc 213 Banks Rd Fayetteville GA 30214 Ph: (770) 629-1917 |
| NPI Number | 1194331439 |
|---|---|
| Provider Enumeration Date | 09/22/2020 |
| Last Update Date | 05/17/2021 |
| Medicare PECOS PAC ID | 6103234802 |
|---|---|
| Medicare Enrollment ID | O20210419001113 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194331439 | NPI | - | NPPES |
| Provider Name | Tawa Kalytou Sitou |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356979363 PECOS PAC ID: 7911315619 Enrollment ID: I20210419001429 |
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