MEDICARE: OLUSANMI J BABATOLA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	050598	GA

General Provider Information

NPI Number	:	1194799148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUSANMI J BABATOLA MD

Provider Business Mailing Address
First Line	:	P O BOX 381
Second Line	:
City	:	BONAIRE
State	:	GA
Zip	:	31005-0381
Country	:	US
Telephone Number	:	478-988-1222
Fax Number	:

Provider Business Practice Location Address
First Line	:	940 A GA HIGHWAY 96
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-2584
Country	:	US
Telephone Number	:	478-988-1222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	07/08/2007

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