Active NPI
Medogun PA
- Psychiatry Physician
- Columbia, SC
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 21075
- Legal business name
- MEDOGUN PA
- Practice address
- 120 Wildewood Park Dr
Suite a
Columbia, SC 29223-4300 - Phone
- (803) 788-7882
- NPI assigned
- Feb 8, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Ayodele Adetokunbo Ogunfowora, M.D.
- Title
- Medical Director
- Phone
- (803) 788-7882
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 21075 | SC | Primary |
Addresses
Primary practice location
120 Wildewood Park Dr
Suite a
Columbia, SC 29223-4300
Mailing address
120 Wildewood Park Dr
Suite a
Columbia, SC 29223-4300
Phone (803) 788-7882
Other names 1
- medogun psychiatric associates
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
Enrollment records 1
National Provider Directory
National Provider Directory- Tax ID family
- Medogun PA
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Pediatric Adolescent Medicine Physician
- Columbia, SC
- NPI 1376683391
Locations
120 Wildewood Park Dr
Ste A
Columbia, SC 29223
Phone (803) 360-1363
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Psychiatry Physician
- Columbia, SC
- NPI 1073578506
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170892800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1730229683",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 WILDEWOOD PARK DR",
"address_2": "SUITE A",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292234300",
"telephone_number": "803-788-7882"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 WILDEWOOD PARK DR",
"address_2": "SUITE A",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292234300",
"telephone_number": "803-788-7882"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MEDOGUN PA",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-08",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "OGUNFOWORA",
"authorized_official_first_name": "AYODELE",
"authorized_official_middle_name": "ADETOKUNBO",
"authorized_official_title_or_position": "MEDICAL DIRECTOR",
"authorized_official_telephone_number": "803-788-7882",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "SC",
"license": "21075",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "medogun psychiatric associates",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.