MEDICARE: DR. TOLULOPE ABIODUN OLUNUGA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	044559	GA

General Provider Information

NPI Number	:	1063441061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOLULOPE ABIODUN OLUNUGA M.D.

Provider Business Mailing Address
First Line	:	364 CHERINGTON LN
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-2041
Country	:	US
Telephone Number	:	770-822-2147
Fax Number	:

Provider Business Practice Location Address
First Line	:	3931 MUNDY MILL RD
Second Line	:
City	:	OAKWOOD
State	:	GA
Zip	:	30566-3413
Country	:	US
Telephone Number	:	404-321-6111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	07/08/2007

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