Provider Demographics
NPI:1013901222
Name:MORAFA, OLAWALE ADETAYO (MD)
Entity type:Individual
Prefix:DR
First Name:OLAWALE
Middle Name:ADETAYO
Last Name:MORAFA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2693 UNION AVENUE EXT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-4403
Mailing Address - Country:US
Mailing Address - Phone:901-722-0088
Mailing Address - Fax:901-722-0082
Practice Address - Street 1:2693 UNION AVENUE EXT
Practice Address - Street 2:SUITE 100
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-4403
Practice Address - Country:US
Practice Address - Phone:901-722-0088
Practice Address - Fax:901-722-0082
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36735207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ010674Medicaid
TN103I081467Medicare PIN
TNH74566Medicare UPIN