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General NPI Number Information
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NPI Number | 1912171489
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Entity Type | Organization
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Legal Business Name | RIVERDALE BEHAVIORAL HEALTH, PC
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 07/27/2010
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Provider Practice Location Address
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Address Line | 8135 GOODMAN RD
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-2103
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Country | US
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Telephone | 662-893-7102
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Fax |
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Provider Business Mailing Address
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Address Line | 4700 WHITE PASS DR
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City | COLLIERVILLE
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State | TN
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Zip | 38017-3462
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Country | US
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Telephone | 901-385-2342
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Fax | 901-382-0140
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Authorized Official
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Title or Position | PSYCHITRIST
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Name | DR. OLAYINKA OLANIYI AKINWUMIJU
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Credential | M.D.
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Telephone | 901-385-2342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 16950
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License Number State | MS
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