Provider Demographics
NPI:1659560647
Name:ODUWOLE ORGANIZATION INC
Entity Type:Organization
Organization Name:ODUWOLE ORGANIZATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADEFIFAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:ODUWOLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-571-2956
Mailing Address - Street 1:1415 HIGHWAY 85 N STE 310-296
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7738
Mailing Address - Country:US
Mailing Address - Phone:678-571-2956
Mailing Address - Fax:770-234-5103
Practice Address - Street 1:1415 HIGHWAY 85 N STE 310-296
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7738
Practice Address - Country:US
Practice Address - Phone:678-571-2956
Practice Address - Fax:770-234-5103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042381207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty