Provider Demographics
NPI:1114976743
Name:MILESTONE FAMILY MEDICINE
Entity Type:Organization
Organization Name:MILESTONE FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OBAFEMI
Authorized Official - Middle Name:OLUSEUN
Authorized Official - Last Name:OKUWOBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-414-0337
Mailing Address - Street 1:PO BOX 15531
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30333-0531
Mailing Address - Country:US
Mailing Address - Phone:770-414-0337
Mailing Address - Fax:770-414-0354
Practice Address - Street 1:1438 MCLENDON DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-1802
Practice Address - Country:US
Practice Address - Phone:770-414-0337
Practice Address - Fax:770-414-0354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050325207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty