Provider Demographics
NPI:1033963590
Name:FASHUGBA, MORIAMO ADEDOYIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MORIAMO
Middle Name:ADEDOYIN
Last Name:FASHUGBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MORIAMO
Other - Middle Name:ADEDOYIN
Other - Last Name:JEBODA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2501 N PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1785
Mailing Address - Country:US
Mailing Address - Phone:229-433-1000
Mailing Address - Fax:
Practice Address - Street 1:2501 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1785
Practice Address - Country:US
Practice Address - Phone:229-433-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16434207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine