Provider Demographics
NPI:1013000744
Name:DARANIJOH, ABDUL BABAJIDE (OD)
Entity Type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:BABAJIDE
Last Name:DARANIJOH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O.BOX 3151
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809
Mailing Address - Country:US
Mailing Address - Phone:812-219-3207
Mailing Address - Fax:866-687-8165
Practice Address - Street 1:3412 WRIGHTSBORO RD
Practice Address - Street 2:SUITE 905
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-2500
Practice Address - Country:US
Practice Address - Phone:706-736-3937
Practice Address - Fax:706-736-3938
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002274152W00000X
SC1489152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA203954936OtherTAX ID NUMBER