Provider Demographics
NPI:1134689706
Name:SOYEMI, TEMITOPE O (MD)
Entity Type:Individual
Prefix:DR
First Name:TEMITOPE
Middle Name:O
Last Name:SOYEMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TEMITOPE
Other - Middle Name:O
Other - Last Name:OLUGBODI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1199 PRINCE AVE # 70
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2797
Mailing Address - Country:US
Mailing Address - Phone:706-475-7055
Mailing Address - Fax:
Practice Address - Street 1:1270 PRINCE AVE STE 201
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2789
Practice Address - Country:US
Practice Address - Phone:706-475-7055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program