Provider Demographics
NPI:1669935516
Name:BEWAJI, OLUWATOSIN AYODEJI (MD)
Entity type:Individual
Prefix:DR
First Name:OLUWATOSIN
Middle Name:AYODEJI
Last Name:BEWAJI
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 1:965 RIDGE LAKE BLVD STE 315
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36 CAPITAL WAY STE E
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:TN
Practice Address - Zip Code:38004-7986
Practice Address - Country:US
Practice Address - Phone:901-837-6801
Practice Address - Fax:901-837-6812
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN64870208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics