Provider Demographics
NPI:1831274117
Name:AYO, OLAWUMI OLUBUKOLA (MD)
Entity type:Individual
Prefix:DR
First Name:OLAWUMI
Middle Name:OLUBUKOLA
Last Name:AYO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:OLAWUMI
Other - Middle Name:OLUBUKOLA
Other - Last Name:AYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1701 JIMMY COVE
Mailing Address - Street 2:
Mailing Address - City:LA VERGNE
Mailing Address - State:TN
Mailing Address - Zip Code:37086-2566
Mailing Address - Country:US
Mailing Address - Phone:615-793-2788
Mailing Address - Fax:
Practice Address - Street 1:1771 MADISON STREET
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4990
Practice Address - Country:US
Practice Address - Phone:678-441-8530
Practice Address - Fax:931-551-1034
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40846207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine