Healthcare Provider Details

I. General information

NPI: 1891899449
Provider Name (Legal Business Name): OLURANTI A ALADESANMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 SIXES RD STE 265
HOLLY SPRINGS GA
30115
US

IV. Provider business mailing address

6600 PEACHTREE DUNWOODY RD STE 325
ATLANTA GA
30328-6773
US

V. Phone/Fax

Practice location:
  • Phone: 770-720-2221
  • Fax: 770-720-2282
Mailing address:
  • Phone: 404-876-1906
  • Fax: 404-256-8506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57918
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: