Provider Demographics
NPI:1225005598
Name:TAIWO, OLUFEMI ABIODUN (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUFEMI
Middle Name:ABIODUN
Last Name:TAIWO
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 1:110 BRAXTON CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1968
Mailing Address - Country:US
Mailing Address - Phone:678-610-7100
Mailing Address - Fax:678-610-7111
Practice Address - Street 1:110 BRAXTON CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1968
Practice Address - Country:US
Practice Address - Phone:678-610-7100
Practice Address - Fax:678-610-7111
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-04
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0516062084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000973629BMedicaid
GA000973629AMedicaid
GA000973629CMedicaid
GA000973629CMedicaid
GA26BDJCLMedicare ID - Type Unspecified