Healthcare Provider Details

I. General information

NPI: 1215678826
Provider Name (Legal Business Name): DR. OLUWASEGUN MATTHEW AKINTI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 FOREST DR
COLUMBIA SC
29204-2026
US

IV. Provider business mailing address

1 BROOKDALE PLZ
BROOKLYN NY
11212-3139
US

V. Phone/Fax

Practice location:
  • Phone: 803-256-5855
  • Fax:
Mailing address:
  • Phone: 718-240-6205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number97706
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: