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General NPI Number Information
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NPI Number | 1144458183
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Entity Type | Organization
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Legal Business Name | MOFDAPS AND COMPANY
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Dates
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Enumeration Date | 06/29/2009
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Last Update Date | 10/28/2009
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Provider Practice Location Address
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Address Line | 1203 48TH AVE N 202
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City | MYRTLE BEACH
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State | SC
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Zip | 29577-5425
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Country | US
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Telephone | 843-449-2576
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Fax | 843-449-6851
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Provider Business Mailing Address
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Address Line | PO BOX 50817
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City | MYRTLE BEACH
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State | SC
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Zip | 29579-0014
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Country | US
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Telephone | 843-449-2576
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Fax | 843-449-6851
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Authorized Official
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Title or Position | OWNER
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Name | DR. ADEDAPO MOFOLUS ODUWOLE
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Credential | M.D.
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Telephone | 843-449-2576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 43425
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 31507
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License Number State | SC
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