Individual
YETUNDE O ORIMOGUNJE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1000 MEDICAL CENTER BLVD, LAWRENCEVILLE, GA 30046-0000
(770) 277-3056
(855) 204-5244
Mailing address
PO BOX 551420, FORT LAUDERDALE, FL 33355-1420
(800) 243-3839
(954) 839-2569
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
059576
GA
207L00000X
Anesthesiology Physician
240933
NY
207L00000X
Anesthesiology Physician
92878
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
227142336A
—
GA
05
—
227142336B
—
GA
05
—
227142336C
—
GA
01
—
415429
WELLCARE
GA
01
—
52231382001
BCBS OF GA
GA
01
—
P00457334
RAILROAD MEDICARE
—
Enumeration date
03/19/2007
Last updated
08/08/2024
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