Provider Demographics
NPI:1194245894
Name:OPAKUNLE, YUSUF ABIODUN (DPM)
Entity type:Individual
Prefix:DR
First Name:YUSUF
Middle Name:ABIODUN
Last Name:OPAKUNLE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 PROFESSIONAL DR STE 130
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-7638
Mailing Address - Country:US
Mailing Address - Phone:770-255-0434
Mailing Address - Fax:770-255-0433
Practice Address - Street 1:600 PROFESSIONAL DR STE 130
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7638
Practice Address - Country:US
Practice Address - Phone:770-255-0434
Practice Address - Fax:770-255-0433
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC682213ES0103X
GAPOD001345213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery