Provider Demographics
NPI:1699989483
Name:MEDILAG NEONATOLOGY, PC
Entity type:Organization
Organization Name:MEDILAG NEONATOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BABATUNDE
Authorized Official - Middle Name:I
Authorized Official - Last Name:ONASANYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-935-0500
Mailing Address - Street 1:3997 LAWRENCEVILLE HWY NW
Mailing Address - Street 2:STE 230
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2832
Mailing Address - Country:US
Mailing Address - Phone:770-935-0500
Mailing Address - Fax:770-935-0880
Practice Address - Street 1:3997 LAWRENCEVILLE HWY NW
Practice Address - Street 2:STE 230
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2832
Practice Address - Country:US
Practice Address - Phone:770-935-0500
Practice Address - Fax:770-935-0880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050983174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty