MEDICARE: DR. AYOMIDE HENRIETTA ADEYEMI 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	390200000X	Student in an Organized Health Care Education/Training Program		GA

General Provider Information

NPI Number	:	1922948991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AYOMIDE HENRIETTA ADEYEMI MD

Provider Business Mailing Address
First Line	:	677 CHURCH ST NE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-1101
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	582 CONCORD ROAD SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30082
Country	:	US
Telephone Number	:	470-956-4000
Fax Number	:	770-319-5703

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

Provider Enumeration Date	:	03/30/2026
Last Update Date	:	04/06/2026

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