Provider Demographics
NPI:1043472061
Name:TIAMIYU, AFOLABI (MD)
Entity Type:Individual
Prefix:
First Name:AFOLABI
Middle Name:
Last Name:TIAMIYU
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 1:1368 67TH ST
Mailing Address - Street 2:2FL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-6133
Mailing Address - Country:US
Mailing Address - Phone:134-740-1460
Mailing Address - Fax:
Practice Address - Street 1:902 N 7TH ST # 100
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-3234
Practice Address - Country:US
Practice Address - Phone:229-276-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA063140207P00000X, 207R00000X
NY250945207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine