Basic Information
| Provider Information | |||||||||
| NPI: | 1306011077 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OJEWOLE | ||||||||
| FirstName: | ABIOLA | ||||||||
| MiddleName: | OLUTAYO | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2056 DONALD LEE HOLLOWELL PKWY NW STE 1 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303184764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4708903910 | ||||||||
| FaxNumber: | 8774455270 | ||||||||
| Practice Location | |||||||||
| Address1: | 2056 DONALD LEE HOLLOWELL PKWY NW STE 1 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303184764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4708903910 | ||||||||
| FaxNumber: | 8774455270 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2008 | ||||||||
| LastUpdateDate: | 08/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 128423 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 61991 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | G032865196 | 01 | GA | MEDICARE | OTHER |