Provider Demographics
NPI:1861760712
Name:AKINTADE, AKINOLA O (SURGICAL ASSISTANT)
Entity type:Individual
Prefix:
First Name:AKINOLA
Middle Name:O
Last Name:AKINTADE
Suffix:
Gender:M
Credentials:SURGICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2167 NORTHLAKE PKWY STE 106
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4103
Mailing Address - Country:US
Mailing Address - Phone:770-492-8636
Mailing Address - Fax:770-492-8638
Practice Address - Street 1:2167 NORTHLAKE PKWY STE 106
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4103
Practice Address - Country:US
Practice Address - Phone:770-492-8636
Practice Address - Fax:770-492-8638
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA04-143363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical