Provider Demographics
NPI:1013238245
Name:ADAMU, IBRAHIM WIAH (MD)
Entity type:Individual
Prefix:
First Name:IBRAHIM
Middle Name:WIAH
Last Name:ADAMU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 NEWNAN CROSSING BYP
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-2384
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:710 NEWNAN CROSSING BYP
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-2384
Practice Address - Country:US
Practice Address - Phone:770-400-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067269208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100255790OtherKY MEDICAID
IN201186200Medicaid
IN01072970AOtherLICENSE
KY50053200OtherKY PASSPORT
IN412840021Medicare PIN