Basic Information
| Provider Information | |||||||||
| NPI: | 1366796088 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AKINKUOYE | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | OLUSOLA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 264 UNION AVENUE, | ||||||||
| Address2: | APT 4 | ||||||||
| City: | FRAMINGHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017026348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087335951 | ||||||||
| FaxNumber: | 7742444129 | ||||||||
| Practice Location | |||||||||
| Address1: | 264 UNION AVE | ||||||||
| Address2: | APT 4 | ||||||||
| City: | FRAMINGHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017026348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087335951 | ||||||||
| FaxNumber: | 7742444129 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2012 | ||||||||
| LastUpdateDate: | 10/23/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | NP233605 | MA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 233605 | MA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 363LP0808X | RN233605 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.