Provider Demographics
NPI:1124174776
Name:ARIYO, MOJI DEMI (MD)
Entity type:Individual
Prefix:DR
First Name:MOJI
Middle Name:DEMI
Last Name:ARIYO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MOJISOLA
Other - Middle Name:
Other - Last Name:AROWOSEGBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3720 ROXWOOD PARK DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-8511
Mailing Address - Country:US
Mailing Address - Phone:678-357-3822
Mailing Address - Fax:404-778-6160
Practice Address - Street 1:875 JOHNSON FERRY RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1418
Practice Address - Country:US
Practice Address - Phone:404-778-6100
Practice Address - Fax:404-778-6160
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051905207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA051905OtherLICENSE
GABA7988415OtherDEA NUMBER
GAH78517Medicare UPIN