Provider Demographics
NPI:1225031651
Name:FAWIBE, OLADAPO O I (MD)
Entity Type:Individual
Prefix:DR
First Name:OLADAPO
Middle Name:O
Last Name:FAWIBE
Suffix:I
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 1:811 13TH ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2700
Mailing Address - Country:US
Mailing Address - Phone:706-823-6177
Mailing Address - Fax:
Practice Address - Street 1:811 13TH ST
Practice Address - Street 2:SUITE 11
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2700
Practice Address - Country:US
Practice Address - Phone:706-823-6177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043608207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000754982CMedicaid
GA11SCGRVOtherMEDICARE