Provider Demographics
NPI:1780062661
Name:OLUMESI, KEHINDE RAJI (MD)
Entity type:Individual
Prefix:
First Name:KEHINDE
Middle Name:RAJI
Last Name:OLUMESI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 OLD NORCROSS RD STE 260
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4981
Mailing Address - Country:US
Mailing Address - Phone:770-637-7662
Mailing Address - Fax:
Practice Address - Street 1:771 OLD NORCROSS RD STE 260
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4981
Practice Address - Country:US
Practice Address - Phone:770-962-5040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA76876207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology