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General NPI Number Information
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NPI Number | 1962451757
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Entity Type | Individual
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Provider Name | ENIOLA O OTUSESO MD
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Gender | Female
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | ANDERSON REGIONAL MEDICAL CENTER 2124 14TH STREET
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City | MERIDIAN
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State | MS
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Zip | 39301
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Country | US
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Telephone | 678-701-8267
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 250385
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City | ATLANTA
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State | GA
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Zip | 30325-1385
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Country | US
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Telephone | 706-267-4999
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Fax | 678-397-0065
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 55269
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0026308
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 18694
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License Number State | MS
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