Healthcare Provider Details

I. General information

NPI: 1245337708
Provider Name (Legal Business Name): HAOLAT ABIOLA BABALAKIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 PEACHTREE INDUSTRIAL BLVD STE 4102
BERKELEY LAKE GA
30071-5737
US

IV. Provider business mailing address

5805 STATE BRIDGE RD SUITE G-106
JOHNS CREEK GA
30097-8220
US

V. Phone/Fax

Practice location:
  • Phone: 678-686-3233
  • Fax:
Mailing address:
  • Phone: 770-686-3233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number062467
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number062467
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: