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General NPI Number Information
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NPI Number | 1245521905
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Entity Type | Individual
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Provider Name | OLUSOLA OBAYOMI-DAVIES MD
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Gender | Male
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Dates
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Enumeration Date | 04/28/2011
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Last Update Date | 12/03/2019
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Provider Practice Location Address
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Address Line | 320 KENNESTONE HOSPITAL BLVD STE LL1
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City | MARIETTA
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State | GA
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Zip | 30060
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Country | US
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Telephone | 770-793-7500
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Fax | 770-793-7985
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Provider Business Mailing Address
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Address Line | 805 SANDY PLAINS ROAD MEDICAL STAFF SERVICES
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City | MARIETTA
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State | GA
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Zip | 30066-6340
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Country | US
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Telephone |
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | MD457543
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 84047
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License Number State | GA
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