Individual
DR. OLALEKAN HENRY AJIBOWO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
413 POTTERY FACTORY DR, COMMERCE, GA 30529-6682
(706) 423-9449
(706) 423-9443
Mailing address
413 POTTERY FACTORY DR, COMMERCE, GA 30529-6682
(706) 423-9449
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
059896
GA
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
059896
GA
208VP0000X
Pain Medicine Physician
059896
GA
208VP0014X
Interventional Pain Medicine Physician
059896
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
012327700
—
FL
05
—
029471605C
—
GA
05
—
029471605E
—
GA
05
—
029471605I
—
GA
05
—
029471605J
—
GA
05
—
029471605K
—
GA
05
—
029471605L
—
GA
05
—
029471605M
—
GA
Enumeration date
08/06/2007
Last updated
12/12/2016
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