Healthcare Provider Details

I. General information

NPI: 1225569890
Provider Name (Legal Business Name): CHRISTANA OLUWASOLA AJEWOLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 N CHURCH ST
GREENSBORO NC
27401-1007
US

IV. Provider business mailing address

1121 N CHURCH ST
GREENSBORO NC
27401-1007
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-6500
  • Fax:
Mailing address:
  • Phone: 336-832-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number2023-01977
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2023-01977
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: