Provider Demographics
NPI:1689645699
Name:ADEBAYO, ADETOKUNBOH MONSURUNDEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ADETOKUNBOH
Middle Name:MONSURUNDEEN
Last Name:ADEBAYO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3290 MEMORIAL DR
Mailing Address - Street 2:SUITE A1
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-3400
Mailing Address - Country:US
Mailing Address - Phone:404-284-1121
Mailing Address - Fax:404-284-0393
Practice Address - Street 1:3290 MEMORIAL DR
Practice Address - Street 2:SUITE A1
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-3400
Practice Address - Country:US
Practice Address - Phone:404-284-1121
Practice Address - Fax:404-284-0393
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042156207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG17901Medicare UPIN
GA11BDQFZMedicare ID - Type Unspecified