Provider Demographics
NPI:1639799752
Name:ADEOYA, IBIMINA (MD)
Entity type:Individual
Prefix:
First Name:IBIMINA
Middle Name:
Last Name:ADEOYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IBIMINA
Other - Middle Name:
Other - Last Name:DAGOGO-JACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:811 CHESTNUT PL
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-4467
Mailing Address - Country:US
Mailing Address - Phone:713-569-9094
Mailing Address - Fax:
Practice Address - Street 1:1701 VETERANS DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-4928
Practice Address - Country:US
Practice Address - Phone:256-629-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-18
Last Update Date:2024-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA98459208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist