Provider Demographics
NPI:1043578677
Name:LANE, OLABISI POPOOLA (MD, PHARM D)
Entity Type:Individual
Prefix:
First Name:OLABISI
Middle Name:POPOOLA
Last Name:LANE
Suffix:
Gender:F
Credentials:MD, PHARM D
Other - Prefix:
Other - First Name:OLABISI
Other - Middle Name:ADEREMILEKUN
Other - Last Name:POPOOLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PHARMD
Mailing Address - Street 1:1364 CLIFTON RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1059
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1364 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1716
Practice Address - Country:US
Practice Address - Phone:404-778-5778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA078858207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology