Basic Information
| Provider Information | |||||||||
| NPI: | 1235171885 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COKER | ||||||||
| FirstName: | OLUMIDE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 750 TOWNPARK LN NW | ||||||||
| Address2: | |||||||||
| City: | KENNESAW | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301445579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013464888 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1221 MERCANTILE LN | ||||||||
| Address2: | |||||||||
| City: | LARGO | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207745374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016185500 | ||||||||
| FaxNumber: | 3016185673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 01/18/2022 | ||||||||
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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 | 207R00000X | D0062141 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 0101237145 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 081610 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.