Basic Information
Provider Information
NPI: 1356334668
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AKINNUSI
FirstName: MOROHUNFOLU
MiddleName: E
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 119 AMBULANCE DR STE 202
Address2:  
City: CARROLLTON
State: GA
PostalCode: 301173857
CountryCode: US
TelephoneNumber: 7708388710
FaxNumber: 7708388563
Practice Location
Address1: 705 DIXIE ST
Address2:  
City: CARROLLTON
State: GA
PostalCode: 301173818
CountryCode: US
TelephoneNumber: 7708129297
FaxNumber: 7708128755
Other Information
ProviderEnumerationDate: 08/23/2005
LastUpdateDate: 02/14/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RP1001X064741GAN Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
207RS0012X064741GAN Allopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
207RC0200X064741GAY Allopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine

No ID Information.


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