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General NPI Number Information
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NPI Number | 1962990648
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Entity Type | Individual
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Provider Name | EBENEZER ADEBOYE DAWODU MD
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Gender | Male
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Dates
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Enumeration Date | 04/27/2018
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Last Update Date | 08/26/2024
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Provider Practice Location Address
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Address Line | 601A, PROFESSIONAL DRIVE SUITE 235
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046
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Country | US
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Telephone | 470-292-3957
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Fax | 470-292-3683
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Provider Business Mailing Address
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Address Line | PO BOX 3877
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City | JOLIET
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State | IL
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Zip | 60434-3877
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Country | US
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Telephone | 815-714-7149
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Fax | 815-435-5080
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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 | 100910
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 100910
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License Number State | GA
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