Individual
DR. SIMON OLALEKAN OKEWOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
17 CENTRE PLAZA DR, JACKSON, TN 38305-2862
(731) 512-0104
(731) 668-7388
Mailing address
17 CENTRE PLAZA DR, JACKSON, TN 38305-2862
(731) 512-0104
(731) 668-7388
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
25MB08388000
NJ
207RC0000X
Cardiovascular Disease Physician
2572
TN
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
2572
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1396033379
NPI
TN
01
—
2572
STATE LICENSE
TN
Enumeration date
04/22/2008
Last updated
10/30/2023
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