Provider Demographics
NPI:1760497317
Name:OMITOWOJU, AKINLOLU (MD)
Entity Type:Individual
Prefix:DR
First Name:AKINLOLU
Middle Name:
Last Name:OMITOWOJU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHNSON
Other - Middle Name:AKINLOLU
Other - Last Name:OMITOWOJU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 853
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30237-0853
Mailing Address - Country:US
Mailing Address - Phone:478-804-1120
Mailing Address - Fax:
Practice Address - Street 1:2955 N COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-8795
Practice Address - Country:US
Practice Address - Phone:478-453-1085
Practice Address - Fax:478-453-1056
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019313207P00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery