1922948991 NPI number — DR. AYOMIDE HENRIETTA ADEYEMI MD

Table of content: DR. AYOMIDE HENRIETTA ADEYEMI MD (NPI 1922948991)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922948991 NPI number — DR. AYOMIDE HENRIETTA ADEYEMI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADEYEMI
Provider First Name:
AYOMIDE
Provider Middle Name:
HENRIETTA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1922948991
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
677 CHURCH ST NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30060-1101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
582 CONCORD ROAD SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMYRNA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
470-956-4000
Provider Business Practice Location Address Fax Number:
770-319-5703
Provider Enumeration Date:
03/30/2026

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: 390200000X , 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)





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