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1164591913 NPI number — SUNDAY A FAWOLE DDS, MD

NPI Number: 1164591913
Health Care Provider/Practitioner: SUNDAY A FAWOLE DDS, MD

Information about “1164591913” NPI (SUNDAY A FAWOLE DDS, MD) exists in 1164591913 in HTML format HTML  |  1164591913 in plain Text format TXT  |  1164591913 in PDF (Portable Document Format) PDF  |  1164591913 in an XML format XML  formats.

NPI Number : 1164591913 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1164591913",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FAWOLE",
    "FirstName": "SUNDAY",
    "MiddleName": "A",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DDS, MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2395 SCENIC HWY S",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SNELLVILLE",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30078-3134",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "678-377-6830",
    "MailingAddressFaxNumber": "678-377-6836",
    "FirstLinePracticeLocationAddress": "2395 SCENIC HWY S",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SNELLVILLE",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30078-3134",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "678-377-6830",
    "PracticeLocationAddressFaxNumber": "678-377-6836",
    "EnumerationDate": "11/07/2006",
    "LastUpdateDate": "02/21/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207QA0505X",
          "TaxonomyName": "Adult Medicine Physician",
          "LicenseNumber": "55514",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1223G0001X",
          "TaxonomyName": "General Practice Dentistry",
          "LicenseNumber": "DNO12698",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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