Individual
MR. KHARI ABAYOMI OMOLARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
394 IMPERIAL LN SW, BOGUE CHITTO, MS 39629-8231
(601) 996-1758
(601) 797-8406
Mailing address
PO BOX 3129, BROOKHAVEN, MS 39603-7129
(601) 445-1922
(601) 445-1923
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
17619
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000126454
—
MS
05
—
009120058
—
MS
05
—
2522183
—
LA
05
—
3663198
—
LA
Enumeration date
08/22/2006
Last updated
11/16/2023
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