Provider Demographics
NPI:1215022694
Name:AKINWALE, AKINREMI AYODEJI (MD)
Entity Type:Individual
Prefix:DR
First Name:AKINREMI
Middle Name:AYODEJI
Last Name:AKINWALE
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 1:129 JEFFERSON DAVIS BLVD.
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120
Mailing Address - Country:US
Mailing Address - Phone:601-445-1736
Mailing Address - Fax:601-446-1753
Practice Address - Street 1:129 JEFFERSON DAVIS BLVD.
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120
Practice Address - Country:US
Practice Address - Phone:601-445-1736
Practice Address - Fax:601-446-1753
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18228207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1190586Medicaid
MS6403709Medicaid
MS95909671OtherBLUE CROSS OF MS
MSP00145583OtherRR MEDICARE
LA1190586Medicaid
MS6403709Medicaid