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NPI Code Detail

MEDICARE: ABOSEDE IDOWU AKINTAN M.D.

MEDICARE: ABOSEDE IDOWU AKINTAN 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
1207Q00000XFamily Medicine Physician003036GA

General Provider Information

NPI Number : 1225287584
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABOSEDE IDOWU AKINTAN M.D.
Provider Business Mailing Address
First Line : 3505 BRIDGE MILL CT
Second Line :
City : NORCROSS
State : GA
Zip : 30092-7617
Country : US
Telephone Number : 770-393-2903
Fax Number :
Provider Business Practice Location Address
First Line : 1000 CORPORATE CENTER DR STE 200
Second Line :
City : MORROW
State : GA
Zip : 30260-4129
Country : US
Telephone Number : 770-968-6460
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2008
Last Update Date : 09/11/2008

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