Basic Information
| Provider Information | |||||||||
| NPI: | 1194799148 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BABATOLA | ||||||||
| FirstName: | OLUSANMI | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | P O BOX 381 | ||||||||
| Address2: | |||||||||
| City: | BONAIRE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310050381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4789881222 | ||||||||
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| Practice Location | |||||||||
| Address1: | 940 A GA HIGHWAY 96 | ||||||||
| Address2: | |||||||||
| City: | WARNER ROBINS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310882584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4789881222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 050598 | GA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.