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Organization

DR. BOLANLE SOGADE M.D. LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. ALISA MARTIN (BILLING CORDINATOR)
(478) 745-3014
Entity
Organization

Contact information

Practice address
639 HEMLOCK ST, SUITE 101, MACON, GA 31201-6886
(478) 745-3014
(478) 745-9887
Mailing address
639 HEMLOCK ST, SUITE 101, MACON, GA 31201-6886
(478) 745-3014
(478) 745-9887

Taxonomy

Speciality
Code
Description
License number
State
207VX0000X
Obstetrics Physician
Primary
047875
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
322090
WELLCARE
GA
Enumeration date
12/13/2007
Last updated
12/13/2007
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