Provider Demographics
NPI:1841588068
Name:ADEYEMO, TOLULOPE (MD)
Entity type:Individual
Prefix:
First Name:TOLULOPE
Middle Name:
Last Name:ADEYEMO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 CONCORD RD SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-2608
Mailing Address - Country:US
Mailing Address - Phone:770-384-9900
Mailing Address - Fax:904-245-1940
Practice Address - Street 1:562 CONCORD RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-2608
Practice Address - Country:US
Practice Address - Phone:770-384-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME118577207Q00000X
GA93726207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHU996ZMedicare PIN