Provider Demographics
NPI:1205043288
Name:AREMU, BOLAJI (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BOLAJI
Middle Name:
Last Name:AREMU
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 721
Mailing Address - Street 2:
Mailing Address - City:GLENNVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30427-0721
Mailing Address - Country:US
Mailing Address - Phone:912-654-9006
Mailing Address - Fax:912-427-1250
Practice Address - Street 1:FCI
Practice Address - Street 2:2600 HWY 301 SOUTH
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31599-0001
Practice Address - Country:US
Practice Address - Phone:912-427-0870
Practice Address - Fax:912-427-1250
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA02870363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical