Provider Demographics
NPI:1518284884
Name:ORELAJA, ADEGBOYEGA OYEGBENGA (PA)
Entity Type:Individual
Prefix:MR
First Name:ADEGBOYEGA
Middle Name:OYEGBENGA
Last Name:ORELAJA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 BEAR CREEK BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-1864
Mailing Address - Country:US
Mailing Address - Phone:678-791-1234
Mailing Address - Fax:
Practice Address - Street 1:990 BEAR CREEK BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-1864
Practice Address - Country:US
Practice Address - Phone:678-791-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005614363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical