=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992970925
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH DEKALB FAMILY PHYSICIANS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2008
-----------------------------------------------------
Last Update Date | 05/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5243 SNAPFINGER WOODS DR SUITE 104
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30035-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-981-5511
-----------------------------------------------------
Fax | 770-987-6928
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5243 SNAPFINGER WOODS DR SUITE 104
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30035-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-981-5511
-----------------------------------------------------
Fax | 770-987-6928
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | M.D.
-----------------------------------------------------
Name | DR. ADEBAYO A AKINTOBI
-----------------------------------------------------
Credential | M.D., M.P.H.
-----------------------------------------------------
Telephone | 770-981-5511
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 170009
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------