Provider Demographics
NPI:1881753606
Name:AFOLABI-BROWN, OLADIRAN ADEMOLA (MD)
Entity type:Individual
Prefix:DR
First Name:OLADIRAN
Middle Name:ADEMOLA
Last Name:AFOLABI-BROWN
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 4207
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-4207
Mailing Address - Country:US
Mailing Address - Phone:478-745-7925
Mailing Address - Fax:
Practice Address - Street 1:682 HEMLOCK ST
Practice Address - Street 2:#410
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-6883
Practice Address - Country:US
Practice Address - Phone:478-745-7925
Practice Address - Fax:478-745-7885
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051902208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA319755OtherWELL CARE PROVIDER #
GA52012975 002OtherBCBS PROVIDER #
GA52012975 002OtherBCBS PROVIDER #
GA24BCBTKMedicare ID - Type Unspecified