Organization
MOBOLAJI SHALOM OYEBANJO, INC
Active
Organization
MOBOLAJI SHALOM OYEBANJO, INC
Active
Other names
The Potter Behavioral Medicine Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MOBOLAJI OYEBANJO MD (PROVIDER)
(770) 459-8799
Entity
Organization
Contact information
Practice address
307 OLD STONE RD, VILLA RICA, GA 30180-1214
(770) 459-8799
(770) 459-8919
Mailing address
307 OLD STONE RD, VILLA RICA, GA 30180-1214
(770) 459-8799
(770) 459-8919
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0802X
Addiction Psychiatry Physician
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
327161185A
—
GA
05
—
327161185B
—
GA
Enumeration date
12/04/2007
Last updated
10/03/2012
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