Provider Demographics
NPI:1871122929
Name:OLAYIWOLA, SIMBIAT KEHINDE (MD)
Entity type:Individual
Prefix:
First Name:SIMBIAT
Middle Name:KEHINDE
Last Name:OLAYIWOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E CHEVES ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2632
Mailing Address - Country:US
Mailing Address - Phone:843-777-7035
Mailing Address - Fax:843-777-5889
Practice Address - Street 1:801 E CHEVES ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2632
Practice Address - Country:US
Practice Address - Phone:843-777-7035
Practice Address - Fax:843-777-5889
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC89869207RG0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program