Healthcare Provider Details

I. General information

NPI: 1639790983
Provider Name (Legal Business Name): OLUFADEJIMI ATANDA KAREEM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 COLLEGE AVE
CONWAY AR
72034-6297
US

IV. Provider business mailing address

2302 COLLEGE AVE
CONWAY AR
72034-6297
US

V. Phone/Fax

Practice location:
  • Phone: 501-513-5279
  • Fax:
Mailing address:
  • Phone: 501-513-5279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE14589
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number46990
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number100907
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: