Basic Information
| Provider Information | |||||||||
| NPI: | 1902055676 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OJEMUYIWA | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 531 ROSELANE ST NW STE 710 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300606975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6783313297 | ||||||||
| FaxNumber: | 6785817187 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 MARKET PLACE BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | CARTERSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301218716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703867253 | ||||||||
| FaxNumber: | 7703826424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2008 | ||||||||
| LastUpdateDate: | 04/17/2019 | ||||||||
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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 | 207RH0003X | 62268 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1902055676 | 01 | GA | NPI NUMBER | OTHER |