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General NPI Number Information
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NPI Number | 1336374313
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Entity Type | Organization
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Legal Business Name | EMMANUEL O SOYOOLA MD PC
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Dates
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Enumeration Date | 05/20/2009
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Last Update Date | 09/28/2010
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Provider Practice Location Address
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Address Line | 2169 LAWRENCEVILLE HWY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-7710
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Country | US
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Telephone | 770-962-3700
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Fax | 770-962-8063
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Provider Business Mailing Address
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Address Line | 2169 LAWRENCEVILLE HWY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-7710
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Country | US
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Telephone | 770-962-3700
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Fax | 770-962-8063
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. EMMANUEL SOYOOLA
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Credential | M.D,PHD.,F.A.C.O.G.
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Telephone | 770-962-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 53032
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 53032
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 53032
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License Number State | GA
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