DR. MODUPE AGBEYOMI DNP FNP-C NPI 1245715903

NPI Information

NPI: 1245715903
Provider Name: DR. MODUPE AGBEYOMI, DNP, FNP-C
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
13 CORPORATE BLVD NE STE 200
BROOKHAVEN, GA
ZIP 30329
Phone: (770) 557-1079
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DR. Modupe Agbeyomi, DNP, FNP-C is a family nurse practitioner in Brookhaven, GA. DR. Modupe Agbeyomi, DNP, FNP-C NPI is 1245715903. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

13 CORPORATE BLVD NE STE 200
BROOKHAVEN, GA
ZIP 30329-900
Phone: (770) 557-1079
Fax: (770) 872-6621

The NPI 1245715903 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/28/2018 and was last updated on 11/29/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	251F00000X	Home Infusion				No
2	261QI0500X	Clinic/Center	Infusion Therapy			No
3	261QM1000X	Clinic/Center	Migrant Health			No
4	363LP2300X	Nurse Practitioner	Primary Care	F09180151	GEORGIA	No
5	363LS0200X	Nurse Practitioner	School	F09180151	GEORGIA	No
6	363LF0000X	Nurse Practitioner	Family	F09180151	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	F09180151	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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