Healthcare Provider Details

I. General information

NPI: 1316493638
Provider Name (Legal Business Name): TEJUMADE ADELORE M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 PRINCE AVE STE 201
ATHENS GA
30606-2789
US

IV. Provider business mailing address

1420 ASTER IVES DR
LAWRENCEVILLE GA
30045-2261
US

V. Phone/Fax

Practice location:
  • Phone: 706-475-7055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number82811
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number82811
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: