Provider Demographics
NPI:1225646813
Name:BABARINDE, OLOLADE
Entity Type:Individual
Prefix:
First Name:OLOLADE
Middle Name:
Last Name:BABARINDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 WOODSTOCK RD STE 129
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2276
Mailing Address - Country:US
Mailing Address - Phone:404-455-2959
Mailing Address - Fax:
Practice Address - Street 1:885 WOODSTOCK RD STE 129
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2276
Practice Address - Country:US
Practice Address - Phone:404-455-2959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN232905363LP0808X
CANP95016079363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN232905OtherGEORGIA BOARD OF NURSING
GARN232905Medicaid