Provider Demographics
NPI:1811553084
Name:CLEMENT AYANBADEJO LLC
Entity Type:Organization
Organization Name:CLEMENT AYANBADEJO LLC
Other - Org Name:MACLEY FAMILY PRACTICE AND WALK IN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FAMILY PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CLEMENT
Authorized Official - Middle Name:O
Authorized Official - Last Name:AYANBADEJO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-257-2832
Mailing Address - Street 1:2282 MEADOW CHURCH RD STE 200
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-5318
Mailing Address - Country:US
Mailing Address - Phone:678-257-2832
Mailing Address - Fax:470-282-1069
Practice Address - Street 1:2282 MEADOW CHURCH RD STE 200
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-5318
Practice Address - Country:US
Practice Address - Phone:678-372-7880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty