# SHA DIABETES CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063293603
- **Authorized official:** DR. TAI BOLAJI PHARM.D, MBA/MHCA (DR./CEO)
- **Authorized official phone:** (334) 778-7090

## Contact information

- **Practice address:** 172 LUDS WAY, DOTHAN, AL 36304-8803
- **Practice address phone:** (334) 475-0646
- **Practice address fax:** (334) 888-8445
- **Mailing address:** 172 LUDS WAY,, P. O. BOX 8803, DOTHAN, AL 36304-8803
- **Mailing address phone:** (334) 778-7090

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/10/2023
- **Last updated:** 01/12/2024