Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 044714 | GA |
NPI | 1053314823 |
---|---|
Provider Name | Dr. Ekundayo Adedapo Falase |
First Address | Covington, GA 30015-1157 |
Second Address | Conyers, GA 30012-3738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 14/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000924536B | (05) | GA |
G60203 | (02) | GA |