Provider Demographics
NPI:1023170842
Name:AJAYI, GANIAT JAIYESINMI (MD)
Entity type:Individual
Prefix:MRS
First Name:GANIAT
Middle Name:JAIYESINMI
Last Name:AJAYI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HOPE & FAITH
Other - Middle Name:WELLNESS
Other - Last Name:CLINIC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1147
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-0020
Mailing Address - Country:US
Mailing Address - Phone:770-910-9196
Mailing Address - Fax:404-400-2077
Practice Address - Street 1:112 LANTHIER ST
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-8100
Practice Address - Country:US
Practice Address - Phone:770-910-9196
Practice Address - Fax:404-400-2077
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA477762084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA097274712CMedicaid
GAGRP7532Medicare ID - Type Unspecified