MEDICARE: AYODEJI SOTIMEHIN

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	208800000X	Urology Physician	103700	GA

General Provider Information

NPI Number	:	1972969012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYODEJI SOTIMEHIN

Provider Business Mailing Address
First Line	:	1930 BRANNAN RD
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-4310
Country	:	US
Telephone Number	:	678-284-4040
Fax Number	:	678-284-4076

Provider Business Practice Location Address
First Line	:	33 UPPER RIVERDALE RD SW STE 105
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-2642
Country	:	US
Telephone Number	:	770-991-0020
Fax Number	:	770-994-9729

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

Provider Enumeration Date	:	01/05/2016
Last Update Date	:	06/30/2025

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Directions to “ AYODEJI SOTIMEHIN ” Practice Location

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