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NPI Code Detail

MEDICARE: DR. OLUBUSOLA ABIYE BRIMMO MD

MEDICARE: DR. OLUBUSOLA ABIYE BRIMMO 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
1207X00000XOrthopaedic Surgery Physician036139012IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12015017078OTHERMOMISSOURI DIVISION OF PROFESSIONAL REGISTRATION
2T9647OTHERTXTEXAS STATE MEDICAL BOARD

General Provider Information

NPI Number : 1346412426
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. OLUBUSOLA ABIYE BRIMMO MD
Provider Business Mailing Address
First Line : 1220 W WHEELER PKWY
Second Line :
City : AUGUSTA
State : GA
Zip : 30909-6625
Country : US
Telephone Number : 706-721-2741
Fax Number :
Provider Business Practice Location Address
First Line : 1220 W WHEELER PKWY
Second Line :
City : AUGUSTA
State : GA
Zip : 30909-6625
Country : US
Telephone Number : 706-721-2741
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2008
Last Update Date : 06/08/2026

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