Healthcare Provider Details

I. General information

NPI: 1952635146
Provider Name (Legal Business Name): OLABISI BADMUS M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 08/27/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3804 MEETING ST
INDIAN TRAIL NC
28079-6582
US

IV. Provider business mailing address

3804 MEETING ST
INDIAN TRAIL NC
28079-6582
US

V. Phone/Fax

Practice location:
  • Phone: 704-710-6414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number37423
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number37423
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: