Individual
DR. BOLA SOGADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
639 HEMLOCK STREET, SUITE 101, MACON, GA 31201-6889
(478) 745-3014
(478) 745-9887
Mailing address
639 HEMLOCK STREET, SUITE 101, MACON, GA 31201-6889
(478) 745-3014
(478) 745-9887
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
047875
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
322090
WELLCARE
GA
05
—
836352013B
—
GA
Enumeration date
10/03/2006
Last updated
07/08/2007
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