Healthcare Provider Details

I. General information

NPI: 1972466712
Provider Name (Legal Business Name): OLUWATOMILOLA OLUWAPELUMI MAKINDE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: OLUWATOMILOLA OLUWAPELUMI DADA MD

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1495 HICKORY FLAT HWY STE 100
CANTON GA
30115-4266
US

IV. Provider business mailing address

PO BOX 117598
ATLANTA GA
30368-7598
US

V. Phone/Fax

Practice location:
  • Phone: 678-341-6360
  • Fax: 678-626-7900
Mailing address:
  • Phone: 770-442-1911
  • Fax: 770-442-0306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number104967
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: