Individual
ODIANOSEN IDIAHI OBADAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
601 PROFESSIONAL DR STE 235A, LAWRENCEVILLE, GA 30046-7697
(470) 292-3957
(470) 292-3683
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
(815) 741-6830
(815) 741-6832
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
84734
SC
207R00000X
Internal Medicine Physician
MD61234746
WA
207RN0300X
Nephrology Physician
Primary
86371
GA
207RN0300X
Nephrology Physician
MD61234746
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
847347
—
SC
Enumeration date
10/21/2014
Last updated
03/13/2026
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