Individual
AYODELE ADELEKE OLUSANYA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
120 DAVY CROCKETT MALL, TRENTON, TN 38382-2934
(731) 855-2803
(731) 855-1746
Mailing address
42 WILLOW GREEN DR, JACKSON, TN 38305-9756
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
37856
TN
207R00000X
Internal Medicine Physician
Primary
37856
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3895681
—
TN
05
—
3895682
—
TN
05
—
3895683
—
TN
05
—
3895684
—
TN
05
—
3895687
—
TN
01
—
4106219
BCBS
TN
01
—
4109887
BCBS
TN
01
—
4139060
BCBS
TN
01
—
P00376124
RR MEDICARE
TN
01
—
P00380502
RAILROAD MEDICARE
TN
Enumeration date
05/25/2006
Last updated
04/14/2008
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