1326163676 NPI number — DR. AYODELE MORENIKE TEKOBO

Table of content: DR. AYODELE MORENIKE TEKOBO (NPI 1326163676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326163676 NPI number — DR. AYODELE MORENIKE TEKOBO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TEKOBO
Provider First Name:
AYODELE
Provider Middle Name:
MORENIKE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326163676
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1132 ATHENS HWY
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
GRAYSON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30017-1710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-585-4962
Provider Business Mailing Address Fax Number:
470-545-2234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1132 ATHENS HWY
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
GRAYSON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30017-1710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-585-4962
Provider Business Practice Location Address Fax Number:
470-545-2234
Provider Enumeration Date:
03/19/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  022424 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)