Basic Information
| Provider Information | |||||||||
| NPI: | 1639313364 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLUTUNMBI | ||||||||
| FirstName: | YETUNDE | ||||||||
| MiddleName: | O. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 826515 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191826515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8887337271 | ||||||||
| FaxNumber: | 3027330854 | ||||||||
| Practice Location | |||||||||
| Address1: | 3023 MONTCLAIR CIR SE | ||||||||
| Address2: | |||||||||
| City: | SMYRNA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300803796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168071295 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2009 | ||||||||
| LastUpdateDate: | 06/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 81916 | GA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.