Provider Demographics
NPI:1962255042
Name:SADARE, OLUWASEUN CHRISTIANNAH (MD)
Entity type:Individual
Prefix:DR
First Name:OLUWASEUN
Middle Name:CHRISTIANNAH
Last Name:SADARE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:OLUWASEUN
Other - Middle Name:CHRISTIANNAH
Other - Last Name:KONIGBAGBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:677 CHURCH ST NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1101
Mailing Address - Country:US
Mailing Address - Phone:470-956-4000
Mailing Address - Fax:
Practice Address - Street 1:582 CONCORD RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-2616
Practice Address - Country:US
Practice Address - Phone:470-956-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program