Provider Demographics
NPI:1942300769
Name:OGUNYEMI, OLUFEMI A (MD)
Entity Type:Individual
Prefix:
First Name:OLUFEMI
Middle Name:A
Last Name:OGUNYEMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 80883
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30608-0883
Mailing Address - Country:US
Mailing Address - Phone:706-549-8114
Mailing Address - Fax:706-549-7558
Practice Address - Street 1:111 FIELDSTONE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-7106
Practice Address - Country:US
Practice Address - Phone:478-414-9900
Practice Address - Fax:706-286-7089
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA045566207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G82664Medicare UPIN