Provider Demographics
NPI:1518995307
Name:OLUNUGA, DESLYN ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:DESLYN
Middle Name:ANN
Last Name:OLUNUGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DESLYN
Other - Middle Name:
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 466618
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30042-6618
Mailing Address - Country:US
Mailing Address - Phone:404-321-6111
Mailing Address - Fax:404-235-3038
Practice Address - Street 1:1670 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057424207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine