Provider Demographics
NPI:1225287584
Name:AKINTAN, ABOSEDE IDOWU (MD)
Entity Type:Individual
Prefix:
First Name:ABOSEDE
Middle Name:IDOWU
Last Name:AKINTAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 BRIDGE MILL CT
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-7617
Mailing Address - Country:US
Mailing Address - Phone:770-393-2903
Mailing Address - Fax:
Practice Address - Street 1:1000 CORPORATE CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-4129
Practice Address - Country:US
Practice Address - Phone:770-968-6460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003036207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine