Provider Demographics
NPI:1679528491
Name:OSUNKOYA, OJORU (MD)
Entity Type:Individual
Prefix:DR
First Name:OJORU
Middle Name:
Last Name:OSUNKOYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NEE
Other - Middle Name:
Other - Last Name:IDACHABA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4112 E. PONCE DE LEON
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021
Mailing Address - Country:US
Mailing Address - Phone:404-296-7133
Mailing Address - Fax:
Practice Address - Street 1:4112 E. PONCE DE LEON
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021
Practice Address - Country:US
Practice Address - Phone:404-296-7133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23461208000000X
GA059578208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics