1962255042 NPI number — DR. OLUWASEUN CHRISTIANNAH SADARE MD

Table of content: DR. OLUWASEUN CHRISTIANNAH SADARE MD (NPI 1962255042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962255042 NPI number — DR. OLUWASEUN CHRISTIANNAH SADARE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SADARE
Provider First Name:
OLUWASEUN
Provider Middle Name:
CHRISTIANNAH
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:
KONIGBAGBE
Provider Other First Name:
OLUWASEUN
Provider Other Middle Name:
CHRISTIANNAH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962255042
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2024
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:
470-956-4000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
582 CONCORD RD 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:
30082-2616
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:
Provider Enumeration Date:
04/09/2024

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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