Provider Demographics
NPI:1306193016
Name:IJADUOLA, EWALOLA AYO (MD)
Entity Type:Individual
Prefix:DR
First Name:EWALOLA
Middle Name:AYO
Last Name:IJADUOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:595 HURRICANE SHOALS RD NW STE 100
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8762
Mailing Address - Country:US
Mailing Address - Phone:404-645-7150
Mailing Address - Fax:678-433-9152
Practice Address - Street 1:595 HURRICANE SHOALS RD NW STE 100
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8762
Practice Address - Country:US
Practice Address - Phone:404-645-7150
Practice Address - Fax:678-433-9152
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA81738207RN0300X
390200000X
MO2016042861207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program