Provider Demographics
NPI:1154497626
Name:AKINTOBI, ADEBAYO A (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:ADEBAYO
Middle Name:A
Last Name:AKINTOBI
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2663 EASTERLY PL
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-4004
Mailing Address - Country:US
Mailing Address - Phone:770-981-5511
Mailing Address - Fax:770-987-6928
Practice Address - Street 1:5243 SNAPFINGER WOODS DR
Practice Address - Street 2:SUITE 104
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-4000
Practice Address - Country:US
Practice Address - Phone:770-981-5511
Practice Address - Fax:770-987-6928
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055081207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA161704630OtherEIN
GA161704630OtherEIN
GA08BBRLFMedicare ID - Type Unspecified