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General NPI Number Information
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NPI Number | 1205043288
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Entity Type | Individual
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Provider Name | BOLAJI AREMU PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | FCI 2600 HWY 301 SOUTH
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City | JESUP
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State | GA
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Zip | 31599-0001
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Country | US
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Telephone | 912-427-0870
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Fax | 912-427-1250
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Provider Business Mailing Address
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Address Line | PO BOX 721
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City | GLENNVILLE
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State | GA
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Zip | 30427-0721
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Country | US
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Telephone | 912-654-9006
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Fax | 912-427-1250
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 02870
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License Number State | GA
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