MEDICARE: OLATUNJI AWE 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
1	207P00000X	Emergency Medicine Physician	047570	GA
2	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	047570	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	:	1689737686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLATUNJI AWE M.D.

Provider Business Mailing Address
First Line	:	164 TAYLOR CT
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-5359
Country	:	US
Telephone Number	:	912-756-6966
Fax Number	:	912-756-6966

Provider Business Practice Location Address
First Line	:	200 GULF STREAM RD.
Second Line	:
City	:	GARDEN CITY
State	:	GA
Zip	:	31418
Country	:	US
Telephone Number	:	912-963-2506
Fax Number	:	912-756-6966

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	09/11/2025

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