Gani Adeboye

Individual provider Active NPI Radiologic Technologist · College Park, GA

NPI 1780089375 · NPPES record last updated Oct 26, 2014

Key facts

NPI
1780089375
Entity type
Individual (NPI type 1)
Primary specialty
Radiologic Technologist 247100000X
Practice address
4854 Old National Hwy
Suite 172
College Park, GA 30337-6221
Phone
(404) 228-9544
NPI assigned
Oct 26, 2014
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Radiologic Technologist 247100000X Yes

Addresses

Primary practice location

4854 Old National Hwy
Suite 172
College Park, GA 30337-6221

Mailing address

11980 Olmstead Dr
Fayetteville, GA 30215-6687
Phone (678) 886-3821

Other providers in College Park, GA

All providers in College Park, GA · Radiologic Technologist in Georgia

Sources for this page

Verify at the official NPI Registry.