Provider Demographics
NPI:1396577490
Name:JOLAYEMI, OLUMIDE
Entity type:Individual
Prefix:
First Name:OLUMIDE
Middle Name:
Last Name:JOLAYEMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 RIVULET DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-9323
Mailing Address - Country:US
Mailing Address - Phone:470-461-3306
Mailing Address - Fax:
Practice Address - Street 1:200 RIVULET DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-9323
Practice Address - Country:US
Practice Address - Phone:470-461-3306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker