# BOLA SOGADE, MD, LLC

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

## Provider details

- **NPI number:** 1407114739
- **Authorized official:** BOLA SOGADE MD (CEO)
- **Authorized official phone:** (478) 745-3014

## Contact information

- **Practice address:** 639 HEMLOCK ST, MACON, GA 31201-6886
- **Practice address phone:** (478) 745-3014
- **Mailing address:** 639 HEMLOCK ST, MACON, GA 31201-6886
- **Mailing address phone:** (478) 745-3014

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 6409 | GA | Yes |

## Other

- **Enumeration date:** 04/24/2012
- **Last updated:** 04/24/2012