Provider Demographics
NPI:1689737686
Name:AWE, OLATUNJI (MD)
Entity Type:Individual
Prefix:
First Name:OLATUNJI
Middle Name:
Last Name:AWE
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 1:164 TAYLOR CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-5359
Mailing Address - Country:US
Mailing Address - Phone:912-756-6966
Mailing Address - Fax:912-756-6966
Practice Address - Street 1:200 GULF STREAM RD.
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:GA
Practice Address - Zip Code:31418
Practice Address - Country:US
Practice Address - Phone:912-963-2506
Practice Address - Fax:912-756-6966
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047570207P00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00889611AMedicaid
GA1 1 B D S V VMedicare ID - Type Unspecified
GA00889611AMedicaid