Provider Demographics
NPI:1720261407
Name:ADEBOYE, OLUMUYIWA OLUKAYODE (MD)
Entity type:Individual
Prefix:DR
First Name:OLUMUYIWA
Middle Name:OLUKAYODE
Last Name:ADEBOYE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:111 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4157
Mailing Address - Country:US
Mailing Address - Phone:706-803-7106
Mailing Address - Fax:770-999-2424
Practice Address - Street 1:111 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4157
Practice Address - Country:US
Practice Address - Phone:706-803-7106
Practice Address - Fax:770-999-2424
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK35726207RH0002X
GA91178207RH0002X
WI63072207RH0002X
CT047530207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine