Provider Demographics
NPI:1457304008
Name:SULE A SALAMI MDPC
Entity Type:Organization
Organization Name:SULE A SALAMI MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SULE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SALAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-273-3883
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31010-0250
Mailing Address - Country:US
Mailing Address - Phone:229-273-3883
Mailing Address - Fax:229-273-3893
Practice Address - Street 1:116 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-3210
Practice Address - Country:US
Practice Address - Phone:229-273-3883
Practice Address - Fax:229-273-3893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP5123Medicare ID - Type Unspecified