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General NPI Number Information
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NPI Number | 1346244324
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Entity Type | Individual
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Provider Name | OLUSOLA OLANREWAJU OGUNTOLU MD
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Gender | Male
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Dates
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Enumeration Date | 06/08/2005
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Last Update Date | 02/02/2011
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Provider Practice Location Address
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Address Line | 2900 FELICIA ST STE 102
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City | NASHVILLE
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State | TN
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Zip | 37209-4042
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Country | US
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Telephone | 615-321-7255
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Fax | 615-321-7259
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Provider Business Mailing Address
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Address Line | 5543 EDMONDSON PIKE # 44
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City | NASHVILLE
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State | TN
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Zip | 37211-5808
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Country | US
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Telephone | 615-321-7255
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Fax | 615-321-7259
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | MD36290
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License Number State | TN
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