Healthcare Provider Details

I. General information

NPI: 1275762239
Provider Name (Legal Business Name): FOLASADE AJAYI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE
FARMINGTON CT
06030
US

IV. Provider business mailing address

1513 CLEVELAND AVE BLDG 100
EAST POINT GA
30344-6947
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-2853
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4301113696
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301113696
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: