Organization
SOUTHERN CRESCENT PRIMARY CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN OLUBUSOLA OGUNDIPE MD,PHD,CMD (PHYSICIAN/PRESIDENT)
(678) 610-2916
Entity
Organization
Contact information
Practice address
7823 SPIVEY STATION BLVD, SUITE 210, JONESBORO, GA 30236-2886
(678) 610-2916
(678) 610-2925
Mailing address
7823 SPIVEY STATION BLVD, SUITE 210, JONESBORO, GA 30236-2886
(678) 610-2916
(678) 610-2925
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
039193
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000639768B
—
GA
01
—
110239410
RAILROAD MEDICARE
GA
Enumeration date
06/03/2008
Last updated
06/03/2008
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