Provider Demographics
NPI:1548956451
Name:AIGBIREMOLEN, IZI PATIENCE
Entity type:Individual
Prefix:
First Name:IZI
Middle Name:PATIENCE
Last Name:AIGBIREMOLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9735 WINDING WAY LN
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-8717
Mailing Address - Country:US
Mailing Address - Phone:404-369-9612
Mailing Address - Fax:
Practice Address - Street 1:9735 WINDING WAY LN
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30238-8717
Practice Address - Country:US
Practice Address - Phone:404-369-9612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2022139349363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health