Provider Demographics
NPI:1508430943
Name:FAMAKINWA, OLUWABUKOLA NAOMI
Entity Type:Individual
Prefix:
First Name:OLUWABUKOLA
Middle Name:NAOMI
Last Name:FAMAKINWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TANDEM HEALTH FAMILY MEDICINE
Mailing Address - Street 2:1278 NORTH LAFAYETTE DRIVE
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150
Mailing Address - Country:US
Mailing Address - Phone:803-774-4500
Mailing Address - Fax:803-774-4627
Practice Address - Street 1:TANDEM HEALTH FAMILY MEDICINE
Practice Address - Street 2:1278 NORTH LAFAYETTE DRIVE
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150
Practice Address - Country:US
Practice Address - Phone:803-774-4500
Practice Address - Fax:803-774-4627
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL83484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine