Provider Demographics
NPI:1306166178
Name:OLUWOLE, OLUJIMI IDOWU (DO)
Entity type:Individual
Prefix:DR
First Name:OLUJIMI
Middle Name:IDOWU
Last Name:OLUWOLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 LEIGHTON WOODS CT
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-5534
Mailing Address - Country:US
Mailing Address - Phone:770-366-9614
Mailing Address - Fax:
Practice Address - Street 1:505 LEIGHTON WOODS CT
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-5534
Practice Address - Country:US
Practice Address - Phone:770-366-9614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA69322207Q00000X
PAOT013431207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RES000Medicare UPIN