Provider Demographics
NPI:1306011077
Name:OJEWOLE, ABIOLA OLUTAYO (MD)
Entity type:Individual
Prefix:MR
First Name:ABIOLA
Middle Name:OLUTAYO
Last Name:OJEWOLE
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 1:3805 COVINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-2643
Mailing Address - Country:US
Mailing Address - Phone:404-383-1300
Mailing Address - Fax:404-383-0772
Practice Address - Street 1:3805 COVINGTON HWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-2643
Practice Address - Country:US
Practice Address - Phone:404-383-1300
Practice Address - Fax:404-383-0772
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA128423207R00000X
GA61991207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG032865196OtherMEDICARE