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Individual

DR. OLADAPO O FAWIBE I

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
811 13TH ST, SUITE 11, AUGUSTA, GA 30901-2700
(706) 823-6177
Mailing address
811 13TH ST, SUITE 11, AUGUSTA, GA 30901-2700
(706) 823-6177

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
043608
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000754982C
GA
01
11SCGRV
MEDICARE
GA
Enumeration date
05/31/2005
Last updated
09/04/2012
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