Provider Demographics
NPI:1053799973
Name:SANUSI, MONISOLA MODUPE (MD)
Entity type:Individual
Prefix:
First Name:MONISOLA
Middle Name:MODUPE
Last Name:SANUSI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MONISOLA
Other - Middle Name:
Other - Last Name:MODUPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2816 PARTRIDGE DR
Mailing Address - Street 2:B
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-6238
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2336 DAWSON RD
Practice Address - Street 2:1100
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-2800
Practice Address - Country:US
Practice Address - Phone:229-312-8871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005496207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine