Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 47776 | GA |
NPI | 1023170842 |
---|---|
Provider Name | Mrs. Ganiat Jaiyesinmi Ajayi |
First Address | Dacula, GA 30019-0020 |
Second Address | Winder, GA 30680-8100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2006 |
Last Update Date | 08/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
097274712C | (05) | GA |