Healthcare Provider Details

I. General information

NPI: 1558455113
Provider Name (Legal Business Name): BOLA SOGADE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. BOLA ADEKORE

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 HEMLOCK ST STE 101
MACON GA
31201-6889
US

IV. Provider business mailing address

639 HEMLOCK ST STE 101
MACON GA
31201-6889
US

V. Phone/Fax

Practice location:
  • Phone: 478-745-3014
  • Fax: 478-745-9887
Mailing address:
  • Phone: 478-394-6061
  • Fax: 478-787-0694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number047875
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: