MEDICARE: ODUWOLE ORGANIZATION INC

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	207RI0011X	Interventional Cardiology Physician	042381	GA

General Provider Information

NPI Number	:	1659560647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ODUWOLE ORGANIZATION INC

Provider Business Mailing Address
First Line	:	1415 HIGHWAY 85 N STE 310-296
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-7738
Country	:	US
Telephone Number	:	678-571-2956
Fax Number	:	770-234-5103

Provider Business Practice Location Address
First Line	:	1415 HIGHWAY 85 N STE 310-296
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-7738
Country	:	US
Telephone Number	:	678-571-2956
Fax Number	:	770-234-5103

Authorized Official
Title or Position	:	OWNER
Name	:	ADEFIFAYO ODUWOLE
Credential	:	M.D.
Telephone Number	:	678-571-2956

Provider Enumeration Date	:	10/16/2007
Last Update Date	:	05/07/2020

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Directions to “ODUWOLE ORGANIZATION INC ” Practice Location

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