Provider Demographics
NPI:1710038856
Name:MERCY INTERNAL MEDICINE ASSOCIATED PC
Entity Type:Organization
Organization Name:MERCY INTERNAL MEDICINE ASSOCIATED PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUFUNSO
Authorized Official - Middle Name:A
Authorized Official - Last Name:OJO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-484-3095
Mailing Address - Street 1:8225 MALL PKWY STE 240
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-6995
Mailing Address - Country:US
Mailing Address - Phone:770-484-3092
Mailing Address - Fax:770-484-3096
Practice Address - Street 1:8225 MALL PKWY STE 240
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-6995
Practice Address - Country:US
Practice Address - Phone:770-484-3092
Practice Address - Fax:770-484-3096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
054004207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1316991748OtherNPI FOR DR OJO