Provider Demographics
NPI:1003012824
Name:BABALOLA, OLUFEMI A (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUFEMI
Middle Name:A
Last Name:BABALOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 PIEDMONT AVE NE STE 700
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-2526
Mailing Address - Country:US
Mailing Address - Phone:404-756-5764
Mailing Address - Fax:404-756-5252
Practice Address - Street 1:1513 CLEVELAND AVE BLDG 500
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6903
Practice Address - Country:US
Practice Address - Phone:404-752-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057928208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery