Healthcare Provider Details

I. General information

NPI: 1740029511
Provider Name (Legal Business Name): OLAMIDE OLUWADAMILDLA AJAYI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 07/24/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 COULTER STREET SUITE 1201
AMARILLO TX
79106
US

IV. Provider business mailing address

1400 COULTER STREET SUITE 1201
AMARILLO TX
79106
US

V. Phone/Fax

Practice location:
  • Phone: 806-414-9786
  • Fax: 806-354-5536
Mailing address:
  • Phone: 806-414-9786
  • Fax: 806-354-5536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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: