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General NPI Number Information
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NPI Number | 1235847526
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Entity Type | Individual
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Provider Name | IBUKUN ADEDOKUN
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Gender | Female
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Dates
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Enumeration Date | 11/07/2022
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Last Update Date | 11/07/2022
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Provider Practice Location Address
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Address Line | 6439 GARNERS FERRY RD
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City | COLUMBIA
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State | SC
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Zip | 29209-1638
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Country | US
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Telephone | 803-776-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 460 CURLEW CIR
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City | SUMTER
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State | SC
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Zip | 29150-5344
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Country | US
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Telephone | 858-736-7314
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Fax |
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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 | 246QM0706X
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Taxonomy Name | Medical Technologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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