MEDICARE: DR. SAMSON ADEWALE MD

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	207Q00000X	Family Medicine Physician	MD.43245	AL
2	207P00000X	Emergency Medicine Physician	92679	GA
3	207Q00000X	Family Medicine Physician	33902	OK
4	207Q00000X	Family Medicine Physician	92679	GA
5	207P00000X	Emergency Medicine Physician	33902	OK
6	207P00000X	Emergency Medicine Physician	MD.43245	AL

General Provider Information

NPI Number	:	1346731635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMSON ADEWALE MD

Provider Business Mailing Address
First Line	:	257 LAWRENCE ST NE UNIT 571
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30061-2309
Country	:	US
Telephone Number	:	404-644-3747
Fax Number	:

Provider Business Practice Location Address
First Line	:	2009 LAWRENCEVILLE SUWANEE RD STE 100
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-2612
Country	:	US
Telephone Number	:	404-644-3747
Fax Number	:

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

Provider Enumeration Date	:	05/23/2018
Last Update Date	:	01/21/2026

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