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General NPI Number Information
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NPI Number | 1538138326
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Entity Type | Individual
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Provider Name | AZEEZ POPOOLA ADEDUNTAN MD
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Gender | Male
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Dates
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Enumeration Date | 03/15/2006
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Last Update Date | 12/06/2007
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Provider Practice Location Address
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Address Line | 435 HAWTHORNE AVE SUITE 600
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City | ATHENS
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State | GA
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Zip | 30606-2574
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Country | US
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Telephone | 706-227-0871
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Fax | 706-227-0865
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Provider Business Mailing Address
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Address Line | 435 HAWTHORNE AVE SUITE 600
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City | ATHENS
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State | GA
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Zip | 30606-2574
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Country | US
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Telephone | 706-227-0871
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Fax | 706-227-0865
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 040293
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License Number State | GA
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