Provider Demographics
NPI:1154386076
Name:DOSUNMU-OGUNBI, SESI O (MD)
Entity type:Individual
Prefix:DR
First Name:SESI
Middle Name:O
Last Name:DOSUNMU-OGUNBI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1062 FORSYTH ST STE 2E
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8631
Mailing Address - Country:US
Mailing Address - Phone:478-633-7330
Mailing Address - Fax:478-633-7360
Practice Address - Street 1:1062 FORSYTH ST STE 2E
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8631
Practice Address - Country:US
Practice Address - Phone:478-633-7330
Practice Address - Fax:478-633-7360
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC164947208000000X, 2080P0206X
ARE-104762080P0206X
GA371922080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009913375Medicaid
AL529913820Medicaid
AL529913820Medicaid
AL009913375Medicaid