Individual
OLUSHESAN MARTINS OGUNDIPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
1199 PRINCE AVE, ATHENS, GA 30606
(706) 475-5076
(260) 373-6348
Mailing address
2727 PACES FERRY RD SE STE 1-1100, ATLANTA, GA 30339-6151
(470) 271-3420
(260) 373-9740
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01069915A
IN
207R00000X
Internal Medicine Physician
059840
GA
208M00000X
Hospitalist Physician
Primary
059840
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000724341
ANTHEM
IN
05
—
200922610
—
IN
Enumeration date
08/01/2007
Last updated
03/08/2021
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