Provider Demographics
NPI:1881132538
Name:DR. JWOLE M.D. INC.
Entity type:Organization
Organization Name:DR. JWOLE M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLUJIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:OLUWOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-366-9614
Mailing Address - Street 1:505 LEIGHTON WOODS CT
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-5534
Mailing Address - Country:US
Mailing Address - Phone:770-366-9614
Mailing Address - Fax:
Practice Address - Street 1:2215 CHESHIRE BRIDGE RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-4234
Practice Address - Country:US
Practice Address - Phone:404-228-3353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty