Provider Demographics
NPI:1124334628
Name:ODEDEYI, TAIWO OLUSHOLA (MD)
Entity type:Individual
Prefix:
First Name:TAIWO
Middle Name:OLUSHOLA
Last Name:ODEDEYI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:222 ARROWHEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-1102
Mailing Address - Country:US
Mailing Address - Phone:678-610-7100
Mailing Address - Fax:678-610-7111
Practice Address - Street 1:222 ARROWHEAD BLVD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1102
Practice Address - Country:US
Practice Address - Phone:678-610-7100
Practice Address - Fax:678-610-7111
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA646222084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry