| Mobolaji Shalom Oyebanjo, Inc | |
|
307 Old Stone Rd Villa Rica GA 30180-1214 | |
| (770) 459-8799 | |
| (770) 459-8919 |
| Full Name | Mobolaji Shalom Oyebanjo, Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 307 Old Stone Rd, Villa Rica, Georgia |
| Authorized Official Name and Position | Mobolaji Oyebanjo (PROVIDER) |
| Authorized Official Contact | 7704598799 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mobolaji Shalom Oyebanjo, Inc 307 Old Stone Rd Villa Rica GA 30180-1214 Ph: (770) 459-8799 | Mobolaji Shalom Oyebanjo, Inc 307 Old Stone Rd Villa Rica GA 30180-1214 Ph: (770) 459-8799 |
| NPI Number | 1922280684 |
|---|---|
| Provider Enumeration Date | 12/04/2007 |
| Last Update Date | 10/03/2012 |
| Medicare PECOS PAC ID | 6204914401 |
|---|---|
| Medicare Enrollment ID | O20080428000562 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922280684 | NPI | - | NPPES |
| 327161185A | Medicaid | GA | |
| 327161185B | Medicaid | GA |
| Provider Name | Omobolaji O Oyebanjo Popoola |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578754503 PECOS PAC ID: 8820010986 Enrollment ID: I20060103000799 |
| Provider Name | Regina F Ayeni |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720375165 PECOS PAC ID: 7517137185 Enrollment ID: I20110909002599 |
| Provider Name | Sabo Uba |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508106873 PECOS PAC ID: 4385889849 Enrollment ID: I20131030001535 |
| Provider Name | Meredith Meece |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306250121 PECOS PAC ID: 7113145285 Enrollment ID: I20140903000105 |
| Provider Name | Louise Wise |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851782965 PECOS PAC ID: 3577866086 Enrollment ID: I20160115001840 |
| Provider Name | Ebote Ngite Nnoko |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346871696 PECOS PAC ID: 0547699662 Enrollment ID: I20200410000197 |
| Provider Name | Jason Lewis Fordyce |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346816865 PECOS PAC ID: 5890189260 Enrollment ID: I20220301000426 |
| Provider Name | Ebony Cameron |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255924577 PECOS PAC ID: 4385011949 Enrollment ID: I20221110002092 |
| Provider Name | Samuel O Fadare |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1184685802 PECOS PAC ID: 7012914997 Enrollment ID: I20240417000494 |
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