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General NPI Number Information
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NPI Number | 1942648944
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Entity Type | Individual
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Provider Name | TIMILEHIN O WUSU MD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2013
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Last Update Date | 02/26/2021
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Provider Practice Location Address
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Address Line | 771 OLD NORCROSS RD STE 105
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4977
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Country | US
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Telephone | 855-647-7678
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Fax | 404-847-4232
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Provider Business Mailing Address
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Address Line | MASSACHUSETTS GENERAL HOSPITAL 55 FRUIT ST.
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City | BOSTON
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State | MA
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Zip | 02114
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Country | US
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Telephone | 617-726-2942
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 84194
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | L-255376
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License Number State | MA
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