Provider Demographics
NPI:1730127713
Name:ADEBISI, JULIUS KOLAWOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIUS
Middle Name:KOLAWOLE
Last Name:ADEBISI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:401 S MAIN ST
Mailing Address - Street 2:SUITE C7
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-1974
Mailing Address - Country:US
Mailing Address - Phone:678-319-9901
Mailing Address - Fax:678-319-9902
Practice Address - Street 1:401 S MAIN ST
Practice Address - Street 2:SUITE C7
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-1974
Practice Address - Country:US
Practice Address - Phone:678-319-9901
Practice Address - Fax:678-319-9902
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA058939207R00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA390122159BMedicaid
GA390122159BMedicaid
GA202I119257Medicare PIN