Healthcare Provider Details

I. General information

NPI: 1114389178
Provider Name (Legal Business Name): OLUSEUN OFUJE AJAYI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JE AJAYI M.D.

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 POST OAK TRITT RD STE 300
MARIETTA GA
30062-1651
US

IV. Provider business mailing address

1030 FOREST OVERLOOK DR SW
ATLANTA GA
30331-8344
US

V. Phone/Fax

Practice location:
  • Phone: 205-964-2924
  • Fax:
Mailing address:
  • Phone: 678-383-9532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number82241
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number82241
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: