Individual
DR. OLANIYI OLABODE OSOFISAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1404 RIVER PL STE 501, BRASELTON, GA 30517-5600
(770) 848-7160
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
053797
GA
207RC0000X
Cardiovascular Disease Physician
148664
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
173191749A
—
GA
Enumeration date
10/23/2006
Last updated
04/09/2025
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