Healthcare Provider Details

I. General information

NPI: 1407086879
Provider Name (Legal Business Name): ADEBAYO KOLAWOLE AKINSOLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 09/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3807 CLAIRMONT RD
CHAMBLEE GA
30341-4911
US

IV. Provider business mailing address

403 CASWYCK TRCE
JOHNS CREEK GA
30022-2695
US

V. Phone/Fax

Practice location:
  • Phone: 917-370-4485
  • Fax:
Mailing address:
  • Phone: 917-370-4485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number67381
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: