Provider Demographics
NPI:1528334042
Name:TUSKEGEE UNIVERSITY
Entity type:Organization
Organization Name:TUSKEGEE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL INSTRUCTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:AINA-POPOOLA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:334-727-8184
Mailing Address - Street 1:115 BASIL O'OCONNOR HALL
Mailing Address - Street 2:
Mailing Address - City:TUSKEGEE
Mailing Address - State:AL
Mailing Address - Zip Code:36088
Mailing Address - Country:US
Mailing Address - Phone:334-727-8184
Mailing Address - Fax:
Practice Address - Street 1:115 BASIL O'OCONNOR HALL
Practice Address - Street 2:
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36088-8184
Practice Address - Country:US
Practice Address - Phone:334-727-8184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-096594273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit