Individual
DR. AYODELE A OGUNFOWORA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
120 WILDEWOOD PARK DR, SUITE A, COLUMBIA, SC 29223-4300
(803) 788-7882
(803) 788-1828
Mailing address
106 NAUTIQUE CIR, COLUMBIA, SC 29229-7328
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
21075
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
210756
—
SC
Enumeration date
04/18/2006
Last updated
11/08/2012
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