Provider Demographics
NPI:1598778946
Name:AKANJI, ABIMBOLA OLUFUNKE (MD)
Entity Type:Individual
Prefix:DR
First Name:ABIMBOLA
Middle Name:OLUFUNKE
Last Name:AKANJI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1867 REMOUNT RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-7401
Mailing Address - Country:US
Mailing Address - Phone:704-865-3848
Mailing Address - Fax:704-854-3086
Practice Address - Street 1:1867 REMOUNT RD
Practice Address - Street 2:SUITE H
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-7401
Practice Address - Country:US
Practice Address - Phone:704-865-3848
Practice Address - Fax:704-854-3086
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012375532084P0800X, 2084P0804X
NC2015-022542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1659424448OtherMEDICAID - NPI
VAH40742Medicare UPIN
VA1659424448OtherMEDICAID - NPI