Provider Demographics
NPI:1366628091
Name:ADISA, OLUFOLAKE (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUFOLAKE
Middle Name:
Last Name:ADISA
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 1:2015 UPPERGATE DRIVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1062
Mailing Address - Country:US
Mailing Address - Phone:404-785-3240
Mailing Address - Fax:
Practice Address - Street 1:2015 UPPERGATE DRIVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1062
Practice Address - Country:US
Practice Address - Phone:404-785-3240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0600322080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology