Healthcare Provider Details

I. General information

NPI: 1164487955
Provider Name (Legal Business Name): MOJIBOLA OLAYINKA SOLAJA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 WILDEWOOD PARK DR SUITE B
COLUMBIA SC
29223-4300
US

IV. Provider business mailing address

120 WILDEWOOD PARK DR SUITE B
COLUMBIA SC
29223-4300
US

V. Phone/Fax

Practice location:
  • Phone: 803-788-7882
  • Fax: 803-788-1828
Mailing address:
  • Phone: 803-788-7882
  • Fax: 803-788-1828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number21514
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: