Provider Demographics
NPI:1245432178
Name:FAPOHUNDA, TEMITOPE K (MD)
Entity Type:Individual
Prefix:DR
First Name:TEMITOPE
Middle Name:K
Last Name:FAPOHUNDA
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 1:1757 ROCK QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7303
Mailing Address - Country:US
Mailing Address - Phone:770-474-7151
Mailing Address - Fax:770-506-1915
Practice Address - Street 1:1757 ROCK QUARRY RD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7303
Practice Address - Country:US
Practice Address - Phone:770-474-7151
Practice Address - Fax:770-506-1916
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059005174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA308694910GMedicaid