Provider Demographics
NPI:1629133103
Name:OKUNDAYE, OSAGIE OSARUME (MD)
Entity Type:Individual
Prefix:DR
First Name:OSAGIE
Middle Name:OSARUME
Last Name:OKUNDAYE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:55 WHITCHER ST NE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1155
Mailing Address - Country:US
Mailing Address - Phone:770-424-6893
Mailing Address - Fax:770-528-9938
Practice Address - Street 1:4550 COBB PARKWAY NORTH NW
Practice Address - Street 2:SUITE 213
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-4180
Practice Address - Country:US
Practice Address - Phone:770-974-8479
Practice Address - Fax:770-974-8710
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2019-12-02
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Provider Licenses
StateLicense IDTaxonomies
GA055488207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA749760085FMedicaid
GA749760085GMedicaid
GA749760085FMedicaid
GA202I069439Medicare PIN