MEDICARE: DR. JIBIKE JOY ADEGBILE M.D.

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	207QG0300X	Geriatric Medicine (Family Medicine) Physician	048967	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	:	1548215163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIBIKE JOY ADEGBILE M.D.

Provider Business Mailing Address
First Line	:	7196 N LAKE DR
Second Line	:	SUITE B
City	:	COLUMBUS
State	:	GA
Zip	:	31909-1693
Country	:	US
Telephone Number	:	706-256-3500
Fax Number	:	706-256-3505

Provider Business Practice Location Address
First Line	:	7196 N LAKE DR
Second Line	:	SUITE B
City	:	COLUMBUS
State	:	GA
Zip	:	31909-1693
Country	:	US
Telephone Number	:	706-256-3500
Fax Number	:	706-256-3505

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	09/30/2010

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