Provider Demographics
NPI:1699977843
Name:AMOSUN, OLUWATOBI ADEYEYE (MD)
Entity type:Individual
Prefix:DR
First Name:OLUWATOBI
Middle Name:ADEYEYE
Last Name:AMOSUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:OLUWATOBI
Other - Middle Name:ADETUTU
Other - Last Name:ADEYEYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4901 NOLENSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-5411
Mailing Address - Country:US
Mailing Address - Phone:615-988-2340
Mailing Address - Fax:
Practice Address - Street 1:4901 NOLENSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-5411
Practice Address - Country:US
Practice Address - Phone:615-988-2340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431370208000000X
TN44277208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1511597Medicaid