Individual
SAMUEL OLANIYI BADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1673 N ROYAL ST, JACKSON, TN 38301-3607
(731) 265-1997
(731) 265-0511
Mailing address
1673 N ROYAL ST, JACKSON, TN 38301-3607
(731) 265-1997
(731) 265-0511
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD34358
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3833490
—
TN
05
—
3858256
—
TN
Enumeration date
05/27/2006
Last updated
10/02/2012
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