Healthcare Provider Details

I. General information

NPI: 1144384827
Provider Name (Legal Business Name): ANTHONY A OLOFINTUYI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009 WARM SPRINGS RD
COLUMBUS GA
31904-7931
US

IV. Provider business mailing address

135 ROCKY SHOALS DR
MIDLAND GA
31820-4817
US

V. Phone/Fax

Practice location:
  • Phone: 706-320-0055
  • Fax: 706-576-5513
Mailing address:
  • Phone: 706-569-1568
  • Fax: 706-576-5513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberGA045309
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: