Provider Demographics
NPI:1811949837
Name:SALAMI, SULE A (MD)
Entity type:Individual
Prefix:
First Name:SULE
Middle Name:A
Last Name:SALAMI
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 250
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31010-0250
Mailing Address - Country:US
Mailing Address - Phone:229-273-3883
Mailing Address - Fax:229-273-3893
Practice Address - Street 1:116 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-3210
Practice Address - Country:US
Practice Address - Phone:229-273-3883
Practice Address - Fax:229-273-3893
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031114207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00393797CMedicaid
E19603Medicare UPIN
GA00393797CMedicaid