Provider Demographics
NPI:1871522516
Name:ONOBRAKPEYA, OLUFUNMILAYO ABIDEMI (MD)
Entity type:Individual
Prefix:DR
First Name:OLUFUNMILAYO
Middle Name:ABIDEMI
Last Name:ONOBRAKPEYA
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 1:209 N CUTHBERT ST
Mailing Address - Street 2:
Mailing Address - City:COLQUITT
Mailing Address - State:GA
Mailing Address - Zip Code:39837-3518
Mailing Address - Country:US
Mailing Address - Phone:229-758-3385
Mailing Address - Fax:
Practice Address - Street 1:208 N CUTHBERT ST
Practice Address - Street 2:
Practice Address - City:COLQUITT
Practice Address - State:GA
Practice Address - Zip Code:39837-3517
Practice Address - Country:US
Practice Address - Phone:229-281-6096
Practice Address - Fax:229-281-6097
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0070849207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003308592AMedicaid
MD611194OtherCAREFIRST MD BCBS