Provider Demographics
NPI:1316250434
Name:ADEBAYO, JOLAADE (MD)
Entity type:Individual
Prefix:DR
First Name:JOLAADE
Middle Name:
Last Name:ADEBAYO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 80883
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30608-0883
Mailing Address - Country:US
Mailing Address - Phone:706-549-8114
Mailing Address - Fax:706-549-7558
Practice Address - Street 1:601 BROAD ST SE
Practice Address - Street 2:SUITE B
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3707
Practice Address - Country:US
Practice Address - Phone:678-989-1515
Practice Address - Fax:770-868-5650
Is Sole Proprietor?:No
Enumeration Date:2010-07-18
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA72496208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I095599Medicare PIN