Provider Demographics
NPI:1346412426
Name:BRIMMO, OLUBUSOLA ABIYE (MD)
Entity type:Individual
Prefix:DR
First Name:OLUBUSOLA
Middle Name:ABIYE
Last Name:BRIMMO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 W WHEELER PKWY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6625
Mailing Address - Country:US
Mailing Address - Phone:706-721-2741
Mailing Address - Fax:
Practice Address - Street 1:1220 W WHEELER PKWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6625
Practice Address - Country:US
Practice Address - Phone:706-721-2741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015017078207X00000X
IL036139012208D00000X
WA60348545208D00000X
GA074284208D00000X
NY297033208D00000X
VA0101244240208D00000X
OH121471208D00000X
KY46121208D00000X
CA130240208D00000X
WI63117-20208D00000X
IN01075497A208D00000X
MI4301108442208D00000X
MO2019037051208D00000X
TXT9647208D00000X
GA74284207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2015017078OtherMISSOURI DIVISION OF PROFESSIONAL REGISTRATION
TXT9647OtherTEXAS STATE MEDICAL BOARD