| Medogun Psychiatric Associates | |
|
120 Wildewood Park Dr Suite A Columbia SC 29223-4300 | |
| (803) 788-7882 | |
| Not Available |
| Full Name | Medogun Psychiatric Associates |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 120 Wildewood Park Dr, Columbia, South Carolina |
| Authorized Official Name and Position | Ayodele Adetokunbo Ogunfowora (MEDICAL DIRECTOR) |
| Authorized Official Contact | 8037887882 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medogun Psychiatric Associates 120 Wildewood Park Dr Suite A Columbia SC 29223-4300 Ph: (803) 788-7882 | Medogun Psychiatric Associates 120 Wildewood Park Dr Suite A Columbia SC 29223-4300 Ph: (803) 788-7882 |
| NPI Number | 1730229683 |
|---|---|
| Provider Enumeration Date | 02/08/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 9133263551 |
|---|---|
| Medicare Enrollment ID | O20100223000143 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730229683 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 21075 (South Carolina) | Primary |
| Provider Name | Ayodele A Ogunfowora |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1073578506 PECOS PAC ID: 7810982808 Enrollment ID: I20040419000906 |
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