Provider Demographics
NPI:1780089375
Name:ADEBOYE, GANI
Entity type:Individual
Prefix:
First Name:GANI
Middle Name:
Last Name:ADEBOYE
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 1:11980 OLMSTEAD DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-6687
Mailing Address - Country:US
Mailing Address - Phone:678-886-3821
Mailing Address - Fax:404-935-9636
Practice Address - Street 1:4854 OLD NATIONAL HWY
Practice Address - Street 2:SUITE 172
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-6221
Practice Address - Country:US
Practice Address - Phone:404-228-9544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-26
Last Update Date:2014-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist