Basic Information
| Provider Information | |||||||||
| NPI: | 1043472061 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TIAMIYU | ||||||||
| FirstName: | AFOLABI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1368 67TH ST | ||||||||
| Address2: | 2FL | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112196133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1347401460 | ||||||||
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| Practice Location | |||||||||
| Address1: | 902 N 7TH ST # 100 | ||||||||
| Address2: | |||||||||
| City: | CORDELE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310153234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2292763100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2008 | ||||||||
| LastUpdateDate: | 10/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 063140 | GA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 250945 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | 063140 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.