Provider Demographics
NPI:1376799338
Name:AKESODE, ABDUL-FAISAL OLATUNDE (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDUL-FAISAL
Middle Name:OLATUNDE
Last Name:AKESODE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5410 MARYLAND WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5064
Mailing Address - Country:US
Mailing Address - Phone:615-377-5667
Mailing Address - Fax:888-241-1404
Practice Address - Street 1:777 HEMLOCK STREET
Practice Address - Street 2:MSC 117
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201
Practice Address - Country:US
Practice Address - Phone:478-633-7550
Practice Address - Fax:478-633-3235
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2018-06-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA061548207R00000X, 207R00000X
GA61548208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA585483063AMedicaid
GA511I110862Medicare PIN
GAP00663023Medicare PIN