Doctor Name: | MR. BOLAJI AREMU |
NPI Number: | 1205043288 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | 02870 |
Business Practice Address: | Fci 2600 Hwy 301 South Jesup, GA - 315990001 |
Business Phone Number: | 9124270870 |
Business Fax Number: | 9124271250 |
Mailing Address: | Po Box 721, GLENNVILLE |
State: | GA |
Postal Code: | 304270721 |
Phone Number: | 9126549006 |
Fax Number: | 9124271250 |
NPI Enumeration Date: | 05/17/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 02870 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |