Basic Information
| Provider Information | |||||||||
| NPI: | 1063806040 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AKINYOKUNBO | ||||||||
| FirstName: | OLALEKAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 CEDAR ST | ||||||||
| Address2: | |||||||||
| City: | METTER | ||||||||
| State: | GA | ||||||||
| PostalCode: | 304393338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9126851726 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 CEDAR ST | ||||||||
| Address2: | |||||||||
| City: | METTER | ||||||||
| State: | GA | ||||||||
| PostalCode: | 304393338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055851280 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2015 | ||||||||
| LastUpdateDate: | 04/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 81386 | GA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 208600000X | 81386 | GA | N | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | FA7835018 | 01 | GA | DEA | OTHER |