Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 059896 | GA |
Y | 111NI0900X | Internist | 059896 | GA |
N | 2081P2900X | Pain Medicine | 059896 | GA |
NPI | 1235320151 |
---|---|
Provider Name | Dr. Olalekan Henry Ajibowo |
First Address | Commerce, GA 30529-6682 |
Second Address | Commerce, GA 30529-6682 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2007 |
Last Update Date | 12/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
012327700 | (05) | FL |
029471605C | (05) | GA |
029471605E | (05) | GA |
029471605I | (05) | GA |
029471605J | (05) | GA |
029471605K | (05) | GA |
029471605L | (05) | GA |
029471605M | (05) | GA |