Provider Demographics
NPI:1548215163
Name:ADEGBILE, JIBIKE JOY (MD)
Entity type:Individual
Prefix:DR
First Name:JIBIKE
Middle Name:JOY
Last Name:ADEGBILE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7196 N LAKE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-1693
Mailing Address - Country:US
Mailing Address - Phone:706-256-3500
Mailing Address - Fax:706-256-3505
Practice Address - Street 1:7196 N LAKE DR
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-1693
Practice Address - Country:US
Practice Address - Phone:706-256-3500
Practice Address - Fax:706-256-3505
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048967207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000876037EMedicaid
GA08BBVZFMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
GA000876037EMedicaid