Provider Demographics
NPI:1659846145
Name:ADELEKE, ADEKEMI
Entity Type:Individual
Prefix:
First Name:ADEKEMI
Middle Name:
Last Name:ADELEKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 S LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-3333
Mailing Address - Country:US
Mailing Address - Phone:404-918-1102
Mailing Address - Fax:
Practice Address - Street 1:3845 WILLOW BEND DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5686
Practice Address - Country:US
Practice Address - Phone:404-918-1102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer