Healthcare Provider Details

I. General information

NPI: 1396830063
Provider Name (Legal Business Name): OLUGBEMISOLA AMOKE OBI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 RICHLAND MEDICAL PARK DR
COLUMBIA SC
29203-6863
US

IV. Provider business mailing address

5 RICHLAND MEDICAL PARK DR
COLUMBIA SC
29203-6863
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-7151
  • Fax: 803-434-6401
Mailing address:
  • Phone: 803-434-7151
  • Fax: 803-434-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number91418
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number31642
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: