Provider Demographics
NPI:1144384827
Name:OLOFINTUYI, ANTHONY A (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:A
Last Name:OLOFINTUYI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:135 ROCKY SHOALS DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820-4817
Mailing Address - Country:US
Mailing Address - Phone:706-569-1568
Mailing Address - Fax:706-576-5513
Practice Address - Street 1:2009 WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-7931
Practice Address - Country:US
Practice Address - Phone:706-320-0055
Practice Address - Fax:706-576-5513
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA045309207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00802986EMedicaid
GA00802986BMedicaid
GA11BDPVPMedicare ID - Type Unspecified
GAG67297Medicare UPIN
GA511G701226Medicare PIN