| 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 |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 05/10/2007 |
| Last Update Date | 12/07/2011 |
| Medicare PECOS PAC ID | 2961545637 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780648568 PECOS PAC ID: 4183601529 Enrollment ID: I20040702000424 |
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