Individual
DR. ADESOLA OMOTAYO FABAYO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
610 S 8TH ST, SUITE F, GRIFFIN, GA 30224-4201
(770) 228-8550
(770) 228-1478
Mailing address
610 S 8TH ST, SUITE F, GRIFFIN, GA 30224-4201
(770) 228-8550
(770) 228-1478
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
45782
GA
207L00000X
Anesthesiology Physician
Primary
045782
GA
207LP2900X
Pain Medicine (Anesthesiology) Physician
045782
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000870669B
—
GA
05
—
00870669A
—
GA
Enumeration date
05/11/2006
Last updated
07/16/2019
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