Provider Demographics
NPI:1487714911
Name:BANKOLE, OLUFUNSHO (MD)
Entity type:Individual
Prefix:
First Name:OLUFUNSHO
Middle Name:
Last Name:BANKOLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2900 PHARR COURT SOUTH NW
Mailing Address - Street 2:SUITE 2103
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-4976
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 NORTHSIDE FORSYTH DR
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7659
Practice Address - Country:US
Practice Address - Phone:770-844-3200
Practice Address - Fax:770-844-3655
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2023-03-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA058391207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine