MEDICARE: DR. CHRISTINE I TOLU-AJAYI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	010365	GA
2	207Q00000X	Family Medicine Physician	2021034914	MO
3	207Q00000X	Family Medicine Physician	88576	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326544255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINE I TOLU-AJAYI MD

Provider Business Mailing Address
First Line	:	4120 FIVE FORKS TRICKUM RD SW STE 104
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-8975
Country	:	US
Telephone Number	:	770-935-9546
Fax Number	:

Provider Business Practice Location Address
First Line	:	4120 FIVE FORKS TRICKUM RD SW STE 104
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-8975
Country	:	US
Telephone Number	:	770-935-9546
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2018
Last Update Date	:	12/18/2023

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