Individual
JIMMY ADESOLA OGUNTUYO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
431 S 5TH ST, GADSDEN, AL 35901-5101
(256) 547-3822
(256) 547-3825
Mailing address
PO BOX 678, GADSDEN, AL 35902-0678
(256) 547-3822
(256) 547-3825
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
26835
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100562
—
AL
05
—
630401143
—
AL
05
—
630402143
—
AL
05
—
630403143
—
AL
05
—
630405143
—
AL
05
—
630406143
—
AL
05
—
630408143
—
AL
05
—
630409143
—
AL
05
—
630410143
—
AL
05
—
630411143
—
AL
05
—
630412143
—
AL
05
—
630413143
—
AL
Enumeration date
05/09/2006
Last updated
08/13/2013
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