Healthcare Provider Details

I. General information

NPI: 1114832938
Provider Name (Legal Business Name): AYO-OLUWA ADEOLA ADESANYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KING EDWARD VII MEMORIAL HOSPITAL 7 POINT FINGER ROAD
PAGET BERMUDA
DV004
BM

IV. Provider business mailing address

2850 DELK RD SE APT 27D
MARIETTA GA
30067-5374
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 441-239-1082
  • Fax: 441-239-1083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: