Provider Demographics
NPI:1003824236
Name:AKINS MEDICAL CLINIC, PC
Entity Type:Organization
Organization Name:AKINS MEDICAL CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLAJIDE
Authorized Official - Middle Name:MORAKINYO
Authorized Official - Last Name:AKINSANYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-543-3072
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35902-0629
Mailing Address - Country:US
Mailing Address - Phone:256-543-3072
Mailing Address - Fax:256-543-3016
Practice Address - Street 1:200 S 3RD ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-4210
Practice Address - Country:US
Practice Address - Phone:256-543-3072
Practice Address - Fax:256-543-3016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18810207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000008431Medicaid
AL000008431Medicare ID - Type Unspecified
AL000008431Medicaid