Healthcare Provider Details

I. General information

NPI: 1144800616
Provider Name (Legal Business Name): OLUWOLE A. BABATUNDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 PHYSICIANS DR STE B
GREER SC
29650-2446
US

IV. Provider business mailing address

109 PHYSICIANS DR STE B
GREER SC
29650-2446
US

V. Phone/Fax

Practice location:
  • Phone: 864-797-9171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number82940
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number24675
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number85629
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: