Provider Demographics
NPI:1285649707
Name:AJAYI, EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:AJAYI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1850 LAKE PARK DR SE
Mailing Address - Street 2:SUITE 218
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-7647
Mailing Address - Country:US
Mailing Address - Phone:770-438-1030
Mailing Address - Fax:770-438-1125
Practice Address - Street 1:1850 LAKE PARK DR SE
Practice Address - Street 2:SUITE 218
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-7647
Practice Address - Country:US
Practice Address - Phone:770-438-1030
Practice Address - Fax:770-438-1125
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA379352084P0800X
GA0379352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000630858CMedicaid