Provider Demographics
NPI:1457318446
Name:WARD, FEYI MOSUNMOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:FEYI
Middle Name:MOSUNMOLA
Last Name:WARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FEYI
Other - Middle Name:
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD PC
Mailing Address - Street 1:7325 W DESCHUTES AVE
Mailing Address - Street 2:SUITE B2
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6705
Mailing Address - Country:US
Mailing Address - Phone:509-374-1190
Mailing Address - Fax:509-374-1270
Practice Address - Street 1:450 NORTHSIDE CHEROKEE BLVD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8015
Practice Address - Country:US
Practice Address - Phone:770-224-1000
Practice Address - Fax:770-224-2451
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA38014207R00000X
GA067040207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1110915Medicaid
WA1110915Medicaid
WAAB37034Medicare ID - Type Unspecified