Provider Demographics
NPI:1477695088
Name:AKINSANYA, OLAJIDE M (MD)
Entity Type:Individual
Prefix:DR
First Name:OLAJIDE
Middle Name:M
Last Name:AKINSANYA
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 629
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35902-0629
Mailing Address - Country:US
Mailing Address - Phone:256-543-3072
Mailing Address - Fax:256-543-3016
Practice Address - Street 1:200 S 3RD ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-4210
Practice Address - Country:US
Practice Address - Phone:256-543-3072
Practice Address - Fax:256-543-3016
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18810207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000008431Medicaid
ALG10244Medicare UPIN
AL000008431Medicare ID - Type Unspecified