OMOBOLAJI OLUSEYI OYEBANJO POPOOLA (NPI# 1578754503) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1578754503 |
Entity Type | Individual |
Full Name | OMOBOLAJI OLUSEYI OYEBANJO POPOOLA |
Credential | MD |
Practice Address |
307 Old Stone Rd Villa Rica GA 30180-1214 |
Practice Telephone | 7704598799 |
Practice Fax Number | 7704598919 |
Mailing Telephone | 7704598799 |
Mailing Fax Number | 7704598919 |
Enumeration Date | 2007-08-06 |
Last Update Date | 2019-11-21 |
Gender Code | F |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2084P0802X |
Psychiatry & Neurology Specialization: Addiction Psychiatry |
053509 | GA | Allopathic & Osteopathic Physicians |
Street Address |
307 OLD STONE RD |
City | VILLA RICA |
State | GA |
Zip Code | 30180-1214 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1740769538 | Khadeja Chowdhury | Physician Assistant | 307 Old Stone Rd, Villa Rica, GA 30180 | 2018-08-13 |
1760932685 | Mardeea Jartu | Counselor | 307 Old Stone Rd, Villa Rica, GA 30180-1214 | 2016-10-04 |
1700209327 | Larry Dewitt Fuller Jr. | Counselor | 307 Old Stone Rd, Villa Rica, GA 30180-1214 | 2014-02-03 |
1881967677 | April C Thomas | Counselor | 307 Old Stone Rd, Villa Rica, GA 30180-1214 | 2012-02-09 |
1386964690 | Potters Hands Institute LLC | Clinic/Center | 307 Old Stone Rd, Villa Rica, GA 30180-1214 | 2010-06-09 |
1922280684 | Mobolaji Shalom Oyebanjo, Inc | Clinic/Center | 307 Old Stone Rd, Villa Rica, GA 30180-1214 | 2007-12-04 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1174161624 | Crucible Communication Therapy LLC | Speech-Language Pathologist | 9765 Walnut Grove Trail, Villa Rica, GA 30180 | 2019-12-16 |
1366802845 | Medic-pearl, LLC | Ambulance | 1108 Charter Oak Ct, Villa Rica, GA 30180 | 2016-02-26 |
1396138368 | Josette Etienne | Nurse Practitioner | 403 Permian Way Suite A, Villa Rica, GA 30180 | 2015-03-13 |
1447690516 | Judith L.m. Thigpen | Nurse Practitioner | 736 Highway 78 West, Minute Clinic, Villa Rica, GA 30180 | 2013-07-03 |
1477890168 | Wesley Douglas Mckenzie | Pharmacist | 2500 Mirror Lake Blvd, Villa Rica, GA 30180 | 2013-01-15 |
1497005359 | Malika Remie Rajendra | Optometrist | 600 Hwy 61, Villa Rica, GA 30180 | 2012-09-18 |
1972876449 | Catherine Elaine Tyson | Pharmacist | 601 Dallas Road, Villa Rica, GA 30180 | 2012-02-14 |
1619262433 | Villa Rica Rx LLC | Pharmacy | 222 West Wilson Street, Villa Rica, GA 30180 | 2011-06-09 |
1851602874 | Jules Chopin Sybert | Nurse Practitioner | 736 W. Bankhead Hwy, Villa Rica, GA 30180 | 2010-06-24 |
1487984019 | Lisa Wood | Occupational Therapy Assistant | 1207 Woods Walk, Villa Rica, GA 30180 | 2010-01-04 |
Find all providers in zip 30180 |
Taxonomy Code | 2084P0802X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Psychiatry & Neurology |
Specialization | Addiction Psychiatry |
Addiction Psychiatry is a subspecialty of psychiatry that focuses on evaluation and treatment of individuals with alcohol, drug, or other substance-related disorders, and of individuals with dual diagnosis of substance-related and other psychiatric disorders. |
Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1821393380 | Tifton Addiction Associates, LLC. D/b/a Tlc Clinic | Psychiatry & Neurology | 2402 North Tift Ave Suite 202, Tifton, GA 31794 | 2011-01-14 |
1760517254 | Todd Estroff | Psychiatry & Neurology | 627 Old Ivy Rd Ne, Atlanta, GA 30342-4319 | 2007-02-23 |
1861534802 | Joseph Francis Griffin IIi | Psychiatry & Neurology | 1677 East Clifton Rd, Atlanta, GA 30307-1289 | 2007-02-13 |
1346253309 | John L Moseri | Psychiatry & Neurology | 4540 Glenwood Rd, Decatur, GA 30032-5166 | 2006-08-14 |
1710997069 | Ayman Mohsen Fareed | Psychiatry & Neurology | 330 Mount Sinai Dr, Dahlonega, GA 30533-2367 | 2006-08-09 |
1639112584 | Susan Kaye Blank | Psychiatry & Neurology | 1846 Old Norcross Rd, Suite 100, Lawrenceville, GA 30044-8801 | 2006-06-14 |
1194716282 | Ramachandra R Paidi | Psychiatry & Neurology | 106 Queen St, Suite 1a, Vidalia, GA 30474-4210 | 2005-10-29 |
1396389185 | Keystone Psychiatric Care LLC | Psychiatry & Neurology | 11030 Jones Bridge Rd Ste 301, Johns Creek, GA 30022-4560 | 2019-11-05 |
1841672789 | Joseph Emmanuel Mathias | Psychiatry & Neurology | 12 Executive Park Dr Ne, Atlanta, GA 30329-2206 | 2015-06-28 |
1093067084 | Kambiz Aflatoon Do | Psychiatry & Neurology | 2150 Peachford Rd, Suite A, Atlanta, GA 30338-6520 | 2012-10-15 |
Find all providers with the same taxonomy |
City | VILLA RICA |
Zip Code | 30180 |
Please comment or provide details below to improve the information on OMOBOLAJI OLUSEYI OYEBANJO POPOOLA.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.