Basic Information
| Provider Information | |||||||||
| NPI: | 1619330297 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AJIBADE | ||||||||
| FirstName: | OLUFEMI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 GATEWOOD AVE | ||||||||
| Address2: | APT312 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372075165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4784760642 | ||||||||
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| Practice Location | |||||||||
| Address1: | 75 BAYLOR DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | BLUFFTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299108965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435405857 | ||||||||
| FaxNumber: | 8435245655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2016 | ||||||||
| LastUpdateDate: | 05/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 83692 | SC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.