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NPI Code Detail

MEDICARE: OYERONKE IDOWU OYEDEJI PT

MEDICARE: OYERONKE IDOWU OYEDEJI PT
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
1225100000XPhysical Therapist9407GA

General Provider Information

NPI Number : 1801035811
Entity Type Code : Individual
Provider Name (Legal Business Name) : OYERONKE IDOWU OYEDEJI PT
Provider Business Mailing Address
First Line : 5343 FOX VALLEY TRCE
Second Line :
City : STONE MOUNTAIN
State : GA
Zip : 30088-2615
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 105 ARNOLD MILL RD
Second Line :
City : WOODSTOCK
State : GA
Zip : 30188-5027
Country : US
Telephone Number : 770-926-0016
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2009
Last Update Date : 02/14/2009

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