Provider Demographics
NPI:1033302013
Name:ADETUNJI, EZEKIEL OLADEJO (MD)
Entity Type:Individual
Prefix:DR
First Name:EZEKIEL
Middle Name:OLADEJO
Last Name:ADETUNJI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 STONEBRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2040
Mailing Address - Country:US
Mailing Address - Phone:731-300-3168
Mailing Address - Fax:731-300-3169
Practice Address - Street 1:150 MURRAY GUARD DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3609
Practice Address - Country:US
Practice Address - Phone:731-300-3168
Practice Address - Fax:731-300-3169
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44164207Q00000X
GA001924207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3002429Medicaid
TN3002429Medicaid