MEDICARE: DR. KINGSLEY E AGBEYEGBE 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	207R00000X	Internal Medicine Physician	047562	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

General Provider Information

NPI Number	:	1649234055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KINGSLEY E AGBEYEGBE MD

Provider Business Mailing Address
First Line	:	1151 CLEVELAND AVE
Second Line	:	SUITE C
City	:	EAST POINT
State	:	GA
Zip	:	30344-3600
Country	:	US
Telephone Number	:	404-305-0004
Fax Number	:	404-305-0494

Provider Business Practice Location Address
First Line	:	1151 CLEVELAND AVE
Second Line	:	SUITE C
City	:	EAST POINT
State	:	GA
Zip	:	30344-3600
Country	:	US
Telephone Number	:	404-305-0004
Fax Number	:	404-305-0494

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	03/18/2008

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