Provider Demographics
NPI:1194081851
Name:AWOJULU, ADETOKUNBO (MD)
Entity type:Individual
Prefix:
First Name:ADETOKUNBO
Middle Name:
Last Name:AWOJULU
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:PO BOX 8818
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31095-8818
Mailing Address - Country:US
Mailing Address - Phone:478-333-6468
Mailing Address - Fax:478-953-6727
Practice Address - Street 1:304 MARGIE DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088
Practice Address - Country:US
Practice Address - Phone:478-333-6432
Practice Address - Fax:478-302-0643
Is Sole Proprietor?:No
Enumeration Date:2012-04-06
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME121902207Q00000X
GA84511207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003228382AMedicaid