Provider Demographics
NPI:1801899539
Name:AJAYI, REX O (MD)
Entity type:Individual
Prefix:DR
First Name:REX
Middle Name:O
Last Name:AJAYI
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:PO BOX 72108
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31708-2108
Mailing Address - Country:US
Mailing Address - Phone:229-435-0832
Mailing Address - Fax:229-435-2857
Practice Address - Street 1:803 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2313
Practice Address - Country:US
Practice Address - Phone:229-435-0832
Practice Address - Fax:229-435-2857
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019123208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00279518AMedicaid
GAB17745Medicare UPIN
GA$$$$$$$$$AMedicare PIN