Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 002274 | GA |
N | 152W00000X | Optometrist | 1489 | SC |
NPI | 1013000744 |
---|---|
Provider Name | Dr. Abdul Babajide Daranijoh |
First Address | Evans, GA 30809 |
Second Address | Augusta, GA 30909-2500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 05/12/2014 |