Provider Demographics
NPI:1528493434
Name:GEORGE, BOLANLE (BSMT(AMT), MPH)
Entity type:Individual
Prefix:
First Name:BOLANLE
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:BSMT(AMT), MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 MITCHELL ST SW
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-3304
Mailing Address - Country:US
Mailing Address - Phone:404-819-4557
Mailing Address - Fax:
Practice Address - Street 1:5181 PAT WILEY DR
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-2457
Practice Address - Country:US
Practice Address - Phone:404-819-4557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL154643246QL0900X, 246QM0706X, 246ZB0600X
GA171M00000X
MN174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
No246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management
No246ZB0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherBiostatistician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174H00000XOther Service ProvidersHealth Educator