Provider Demographics
NPI:1518654805
Name:ADEBISI, TOLUWANI OLUGBENGA (MD)
Entity Type:Individual
Prefix:
First Name:TOLUWANI
Middle Name:OLUGBENGA
Last Name:ADEBISI
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 1:14675 TIMBER PT
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-4526
Mailing Address - Country:US
Mailing Address - Phone:770-990-8427
Mailing Address - Fax:
Practice Address - Street 1:720 WESTVIEW DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-1458
Practice Address - Country:US
Practice Address - Phone:404-756-1393
Practice Address - Fax:404-752-8684
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program