Provider Demographics
NPI:1730479452
Name:ABIODUN, OLUMAYOWA PITAN (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUMAYOWA
Middle Name:PITAN
Last Name:ABIODUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:OLUMAYOWA
Other - Middle Name:OLUFUNKE
Other - Last Name:PITAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2709 MEREDYTH DR STE 340
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-0219
Mailing Address - Country:US
Mailing Address - Phone:229-312-6501
Mailing Address - Fax:229-312-6505
Practice Address - Street 1:2709 MEREDYTH DR STE 340
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707
Practice Address - Country:US
Practice Address - Phone:229-312-6501
Practice Address - Fax:229-312-6505
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA824032086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program