MEDICARE: DR. OLADAYO ADISA OSINUGA 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	207R00000X	Internal Medicine Physician	51703	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	:	1396716312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLADAYO ADISA OSINUGA MD

Provider Business Mailing Address
First Line	:	480 JOHN WESLEY DOBBS AVE NE UNIT 403
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-5328
Country	:	US
Telephone Number	:	404-684-7111
Fax Number	:	866-611-0715

Provider Business Practice Location Address
First Line	:	1170 CLEVELAND AVE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30344-3615
Country	:	US
Telephone Number	:	404-466-1170
Fax Number	:	866-611-0715

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

Provider Enumeration Date	:	01/28/2006
Last Update Date	:	12/18/2020

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