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NPI Code Detail

MEDICARE: ADEFISAYO ODUWOLE MD

MEDICARE: ADEFISAYO ODUWOLE 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
1207RC0000XCardiovascular Disease Physician042381GA
2207R00000XInternal Medicine Physician042381GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952301830
Entity Type Code : Individual
Provider Name (Legal Business Name) : ADEFISAYO ODUWOLE MD
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 :
Provider Business Practice Location Address
First Line : 80 JESSE HILL JR DR SE
Second Line : STE 2E
City : ATLANTA
State : GA
Zip : 30303-3031
Country : US
Telephone Number : 404-616-4422
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2005
Last Update Date : 05/07/2020

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Directions to “ ADEFISAYO ODUWOLE MD” Practice Location

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