Organization
AMANU PHYSICAL MEDICINE & REHABILITATION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ISMAILU O AGBAJE PHD MD (OWNER)
(812) 272-4497
Entity
Organization
Contact information
Practice address
2101 NEWNAN CROSSING BLVD E, NEWNAN, GA 30265-2406
(812) 272-4497
(419) 828-8218
Mailing address
PO BOX 73200, NEWNAN, GA 30271-3200
(812) 272-4497
(419) 828-8218
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
23966
WV
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Enumeration date
05/12/2006
Last updated
10/08/2020
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