Provider Demographics
NPI:1710939194
Name:ADEOGUN, ADEBOLA ADEKUNLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ADEBOLA
Middle Name:ADEKUNLE
Last Name:ADEOGUN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1745 PHOENIX BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5591
Mailing Address - Country:US
Mailing Address - Phone:770-994-9326
Mailing Address - Fax:770-994-4747
Practice Address - Street 1:400 CHARTER BLVD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-4831
Practice Address - Country:US
Practice Address - Phone:770-994-9326
Practice Address - Fax:770-994-4747
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA042517207P00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine