Provider Demographics
NPI:1245790658
Name:AIYANYOR, ALFRED OSAKPOLOR (DO, MPH)
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:OSAKPOLOR
Last Name:AIYANYOR
Suffix:
Gender:M
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JACKSON MADISON COUNTY GENERAL HOSPITAL
Mailing Address - Street 2:8 MEDICAL CENTER DRIVE
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305
Mailing Address - Country:US
Mailing Address - Phone:731-660-7971
Mailing Address - Fax:731-660-8739
Practice Address - Street 1:8 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3947
Practice Address - Country:US
Practice Address - Phone:405-473-8049
Practice Address - Fax:731-660-8739
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAOT019079207R00000X
TN5693207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine