Provider Demographics
NPI:1275184715
Name:BABAJIDE-GBENGA, BOLANLE OLAYINKA (PMHNP)
Entity Type:Individual
Prefix:
First Name:BOLANLE
Middle Name:OLAYINKA
Last Name:BABAJIDE-GBENGA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 PEACHTREE ST NW STE 640
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2450
Mailing Address - Country:US
Mailing Address - Phone:404-575-4785
Mailing Address - Fax:
Practice Address - Street 1:1720 PEACHTREE ST NW STE 640
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2450
Practice Address - Country:US
Practice Address - Phone:404-575-4785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN223717363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health