Provider Demographics
NPI:1346228962
Name:AYEWA, OBAYODE (MD)
Entity Type:Individual
Prefix:
First Name:OBAYODE
Middle Name:
Last Name:AYEWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MEDICAL ARTS CTR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4414
Mailing Address - Country:US
Mailing Address - Phone:912-352-9001
Mailing Address - Fax:912-352-9091
Practice Address - Street 1:15 MEDICAL ARTS CTR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4414
Practice Address - Country:US
Practice Address - Phone:912-352-9001
Practice Address - Fax:912-352-9091
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055657207P00000X
GA55657207Q00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52703694-006OtherBLUECROSS BLUESHIELD
GA08BBSFFOtherGA MEDICARE
GA08BBSFFOtherGA MEDICARE