Provider Demographics
NPI:1275938011
Name:OLUBAJO, OLUKEMI (PHD, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:OLUKEMI
Middle Name:
Last Name:OLUBAJO
Suffix:
Gender:F
Credentials:PHD, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 FAHM STREET
Mailing Address - Street 2:J C LEWIS PRIMARY HEALTH CARE CENTER
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401
Mailing Address - Country:US
Mailing Address - Phone:912-495-8887
Mailing Address - Fax:912-495-8881
Practice Address - Street 1:125 FAHM STREET
Practice Address - Street 2:J C LEWIS PRIMARY HEALTH CARE CENTER
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401
Practice Address - Country:US
Practice Address - Phone:912-495-8887
Practice Address - Fax:912-495-8881
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD001796133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered