Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 070224 | GA |
N | 2081S0010X | Sports Medicine | 070224 | GA |
N | 213ES0000X | Sports Medicine | 070224 | GA |
NPI | 1053502716 |
---|---|
Provider Name | Oluseun Afolabi Olufade |
First Address | Duluth, GA 30096-1407 |
Second Address | Duluth, GA 30096-1407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2007 |
Last Update Date | 31/07/2013 |