Provider Demographics
NPI:1952590705
Name:AJAYI, OLAIDE IFELOLA (MD)
Entity type:Individual
Prefix:
First Name:OLAIDE
Middle Name:IFELOLA
Last Name:AJAYI
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 440100
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244-0100
Mailing Address - Country:US
Mailing Address - Phone:931-906-2004
Mailing Address - Fax:931-906-2009
Practice Address - Street 1:776 WEATHERLY DR
Practice Address - Street 2:SUITE A
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8941
Practice Address - Country:US
Practice Address - Phone:931-906-2004
Practice Address - Fax:931-906-2009
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0066606207R00000X
TN48841207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102101696-0001Medicaid
MD413550400Medicaid
MDP00461544OtherTRAVELERS MEDICARE
WV3810010307Medicaid
MDS199Medicare PIN