Provider Demographics
NPI:1548400013
Name:AKINTOMIDE, OLADOTUN (AA)
Entity Type:Individual
Prefix:
First Name:OLADOTUN
Middle Name:
Last Name:AKINTOMIDE
Suffix:
Gender:M
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 DARLING AVE
Mailing Address - Street 2:DEPT OF ANESTHESIA
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-5246
Mailing Address - Country:US
Mailing Address - Phone:912-338-6511
Mailing Address - Fax:912-338-6512
Practice Address - Street 1:410 DARLING AVE
Practice Address - Street 2:DEPT OF ANESTHESIA
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5246
Practice Address - Country:US
Practice Address - Phone:912-338-6511
Practice Address - Fax:912-338-6512
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005527367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant