MEDICARE: DR. ANTHONY A OLOFINTUYI 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	GA045309	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144384827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY A OLOFINTUYI M.D.

Provider Business Mailing Address
First Line	:	135 ROCKY SHOALS DR
Second Line	:
City	:	MIDLAND
State	:	GA
Zip	:	31820-4817
Country	:	US
Telephone Number	:	706-569-1568
Fax Number	:	706-576-5513

Provider Business Practice Location Address
First Line	:	2009 WARM SPRINGS RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-7931
Country	:	US
Telephone Number	:	706-320-0055
Fax Number	:	706-576-5513

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	09/19/2023

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