# AMANU PHYSICAL MEDICINE & REHABILITATION, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891746228
- **Authorized official:** ISMAILU O AGBAJE PHD MD (OWNER)
- **Authorized official phone:** (812) 272-4497

## Contact information

- **Practice address:** 2101 NEWNAN CROSSING BLVD E, NEWNAN, GA 30265-2406
- **Practice address phone:** (812) 272-4497
- **Practice address fax:** (419) 828-8218
- **Mailing address:** PO BOX 73200, NEWNAN, GA 30271-3200
- **Mailing address phone:** (812) 272-4497
- **Mailing address fax:** (419) 828-8218

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 23966 | WV | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/12/2006
- **Last updated:** 10/08/2020