Provider Demographics
NPI:1649315417
Name:BABALOLA, CECILIA OMOYEMI (MD)
Entity type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:OMOYEMI
Last Name:BABALOLA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3970 FIVE FORKS TRICKUM RD SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2339
Mailing Address - Country:US
Mailing Address - Phone:770-564-6900
Mailing Address - Fax:770-564-6030
Practice Address - Street 1:3970 FIVE FORKS TRICKUM RD SW
Practice Address - Street 2:SUITE A
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2339
Practice Address - Country:US
Practice Address - Phone:770-564-6900
Practice Address - Fax:770-564-6030
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2010-04-20
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Provider Licenses
StateLicense IDTaxonomies
GA058389207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I114675Medicare PIN