Individual
FORTUNATE EHI OVBIAGELE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
29 L V STABLER DR, GREENVILLE, AL 36037-3850
(334) 383-2249
(334) 383-2342
Mailing address
PO BOX 100242, ATLANTA, GA 30384-0242
(334) 383-2247
(334) 383-2342
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
00022241
AL
2084P0805X
Geriatric Psychiatry Physician
Primary
00022241
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009942355
—
AL
01
—
051098107
BCBS INPATIENT
AL
01
—
051098108
BCBS OUTPATIENT
AL
05
—
051550185
—
AL
01
—
260050017
RAILROAD MEDICARE
AL
Enumeration date
07/21/2006
Last updated
11/17/2008
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