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Individual

DR. BAMIDELE ADEKUNLE ADEAGBO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D

Contact information

Practice address
1120 15TH ST, AUGUSTA, GA 30912-0004
(721) 724-3168
Mailing address
2515 CENTER WEST PKWY APT 5H, AUGUSTA, GA 30909-2159
(732) 646-2665

Taxonomy

Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
002331
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
RTP002331
TRAINING PERMIT
GA
Enumeration date
06/28/2007
Last updated
07/08/2007
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