Provider Demographics
NPI:1679577209
Name:OGUNDIPE, AKIN (MD)
Entity Type:Individual
Prefix:DR
First Name:AKIN
Middle Name:
Last Name:OGUNDIPE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WHITCHER ST NE
Mailing Address - Street 2:STE 460
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1171
Mailing Address - Country:US
Mailing Address - Phone:770-427-7389
Mailing Address - Fax:770-427-2845
Practice Address - Street 1:55 WHITCHER ST NE
Practice Address - Street 2:STE 460
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1171
Practice Address - Country:US
Practice Address - Phone:770-427-7389
Practice Address - Fax:770-427-2845
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050237174400000X
GAGA050237207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000918079VMedicaid
GA000918079PMedicaid
GA000918079BMedicaid
GA000918079SMedicaid
GA000918079EMedicaid
GA000918079FMedicaid
GA000918079TMedicaid
GA000918079UMedicaid
GA000918079YMedicaid
GA000918079KMedicaid
GA000918079MMedicaid
GA000918079NMedicaid
GA00918079AMedicaid
GA000918079CMedicaid
GA000918079GMedicaid
GA000918079LMedicaid
GA000918079OMedicaid
GA000918079DMedicaid
GA000918079RMedicaid
GA000918079HMedicaid
GA000918079QMedicaid
GA000918079PMedicaid
GA000918079RMedicaid