Provider Demographics
NPI:1104816990
Name:ADAMOLEKUN, BOLA (MD)
Entity type:Individual
Prefix:
First Name:BOLA
Middle Name:
Last Name:ADAMOLEKUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 SANDSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2073
Mailing Address - Country:US
Mailing Address - Phone:731-661-0588
Mailing Address - Fax:731-661-0589
Practice Address - Street 1:8000 CENTERVIEW PKWY STE 305
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4225
Practice Address - Country:US
Practice Address - Phone:901-261-3500
Practice Address - Fax:901-624-2961
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD388992084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3898161Medicaid
TN3898161Medicare PIN
I20427Medicare UPIN