Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 58385 | GA |
NPI | 1043343387 |
---|---|
Provider Name | Boyede Franklin Ademodi |
First Address | Atlanta, GA 30305-1773 |
Second Address | Jonesboro, GA 30236-2500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 08/07/2007 |