MEDICARE: OLABISI POPOOLA LANE M.D., PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0000X	Pain Medicine Physician	078858	GA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207L00000X	Anesthesiology Physician	078858	GA

General Provider Information

NPI Number	:	1043578677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLABISI POPOOLA LANE M.D., PHARM D

Provider Business Mailing Address
First Line	:	1364 CLIFTON RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-1059
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1364 CLIFTON RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-1716
Country	:	US
Telephone Number	:	404-778-5778
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2012
Last Update Date	:	06/15/2026

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Directions to “ OLABISI POPOOLA LANE M.D., PHARM D” Practice Location

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