Provider Demographics
NPI:1184859027
Name:OBAJULUWA, KOLADE KEHINDE (MD)
Entity Type:Individual
Prefix:
First Name:KOLADE
Middle Name:KEHINDE
Last Name:OBAJULUWA
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 1:6043 PRESTLEY MILL RD STE E
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-2280
Mailing Address - Country:US
Mailing Address - Phone:770-920-2255
Mailing Address - Fax:770-489-3951
Practice Address - Street 1:6043 PRESTLEY MILL RD STE E
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2280
Practice Address - Country:US
Practice Address - Phone:770-920-2255
Practice Address - Fax:770-489-3951
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036127051208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics