Provider Demographics
NPI:1457746265
Name:OYEFULE, OMOBOLANLE OLAJUMOKE (MD)
Entity type:Individual
Prefix:DR
First Name:OMOBOLANLE
Middle Name:OLAJUMOKE
Last Name:OYEFULE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MOBOLA
Other - Middle Name:
Other - Last Name:OYEFULE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:550 PEACHTREE ST NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2212
Mailing Address - Country:US
Mailing Address - Phone:404-778-3712
Mailing Address - Fax:404-778-5033
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2212
Practice Address - Country:US
Practice Address - Phone:404-778-3712
Practice Address - Fax:404-778-5033
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN66708208600000X
390200000X
GA88616208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program