Provider Demographics
NPI:1992970925
Name:SOUTH DEKALB FAMILY PHYSICIANS, LLC
Entity type:Organization
Organization Name:SOUTH DEKALB FAMILY PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEBAYO
Authorized Official - Middle Name:A
Authorized Official - Last Name:AKINTOBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:770-981-5511
Mailing Address - Street 1:5243 SNAPFINGER WOODS DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-4000
Mailing Address - Country:US
Mailing Address - Phone:770-981-5511
Mailing Address - Fax:770-987-6928
Practice Address - Street 1:5243 SNAPFINGER WOODS DR
Practice Address - Street 2:SUITE 104
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-4000
Practice Address - Country:US
Practice Address - Phone:770-981-5511
Practice Address - Fax:770-987-6928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA170009207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6822Medicare PIN