Basic Information
| Provider Information | |||||||||
| NPI: | 1003800996 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAMAKINWA | ||||||||
| FirstName: | ABIODUN | ||||||||
| MiddleName: | O | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4343 WARM SPRINGS RD | ||||||||
| Address2: | # 1804 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319095902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065685000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3000 SCHATULGA RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319073117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065685000 | ||||||||
| FaxNumber: | 7065685339 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 056096 | GA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 056096 | 01 | GA | LICENSE # | OTHER |