Provider Demographics
NPI:1730067125
Name:FADIORA, OLATUNJI EMMANUEL
Entity type:Individual
Prefix:DR
First Name:OLATUNJI
Middle Name:EMMANUEL
Last Name:FADIORA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 S HILLS
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-6038
Mailing Address - Country:US
Mailing Address - Phone:404-343-5330
Mailing Address - Fax:
Practice Address - Street 1:2614 S HILLS
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-6038
Practice Address - Country:US
Practice Address - Phone:404-343-5330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA09895715207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine