Individual
OLUFOWOBI GBADEBO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
116 HILL POND LN, STATESBORO, GA 30458-0872
(912) 489-1629
Mailing address
116 HILL POND LN, STATESBORO, GA 30458-0872
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
46201
WI
2084P0800X
Psychiatry Physician
054096
GA
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
054096
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32497000
—
WI
Enumeration date
10/11/2006
Last updated
07/22/2010
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