Basic Information
| Provider Information | |||||||||
| NPI: | 1104816990 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADAMOLEKUN | ||||||||
| FirstName: | BOLA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 37 SANDSTONE CIR | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383052073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316610588 | ||||||||
| FaxNumber: | 7316610589 | ||||||||
| Practice Location | |||||||||
| Address1: | 8000 CENTERVIEW PKWY STE 305 | ||||||||
| Address2: | |||||||||
| City: | CORDOVA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380184225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012613500 | ||||||||
| FaxNumber: | 9016242961 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2005 | ||||||||
| LastUpdateDate: | 02/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | MD38899 | TN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 3898161 | 05 | TN | MEDICAID |