Healthcare Provider Details

I. General information

NPI: 1427065291
Provider Name (Legal Business Name): OJO M OLADIMEJI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 NASSAU ST
CHARLESTON SC
29403-5513
US

IV. Provider business mailing address

113 ASHLEY HILL DR
GOOSE CREEK SC
29445-7109
US

V. Phone/Fax

Practice location:
  • Phone: 843-722-4112
  • Fax:
Mailing address:
  • Phone: 843-572-9270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number27042
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: