MEDICARE: IRENE OLABODE DO

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	P7014	TX
2	207Q00000X	Family Medicine Physician	5101027723	MI
3	207Q00000X	Family Medicine Physician	02007575A	IN
4	207Q00000X	Family Medicine Physician	326504-01	NY
5	207R00000X	Internal Medicine Physician	05699	KY
6	207Q00000X	Family Medicine Physician	68690	GA

General Provider Information

NPI Number	:	1619297744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE OLABODE DO

Provider Business Mailing Address
First Line	:	1445 WOODMONT LN NW STE 1002
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-2866
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1445 WOODMONT LN NW STE 1002
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-2866
Country	:	US
Telephone Number	:	760-284-5368
Fax Number	:

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

Provider Enumeration Date	:	06/11/2010
Last Update Date	:	02/24/2025

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Directions to “ IRENE OLABODE DO” Practice Location

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