Individual
DR. OLUFISAYO TAYO OTUSANYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.B.CH.B
Contact information
Practice address
135 N PARK PL STE 200, STOCKBRIDGE, GA 30281-7209
(678) 289-7960
Mailing address
135 N PARK PL STE 200, STOCKBRIDGE, GA 30281-7209
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
305582
LA
207RP1001X
Pulmonary Disease Physician
Primary
84957
GA
Other
Enumeration date
06/03/2014
Last updated
07/22/2020
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