Provider Demographics
NPI:1386690923
Name:SESAY, MINKAILU (MD)
Entity Type:Individual
Prefix:
First Name:MINKAILU
Middle Name:
Last Name:SESAY
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:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:
Practice Address - Street 1:852 DACULA RD
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-3185
Practice Address - Country:US
Practice Address - Phone:770-848-9380
Practice Address - Fax:770-848-9381
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10065391OtherAMERIGROUP
GAP00286027OtherRR MEDICARE
GA349829OtherWELLCARE
SCG55700Medicaid
GA435245270EMedicaid
GA52171977-006OtherBCBS
GA52171977-006OtherBCBS
GA435245270EMedicaid