Provider Demographics
NPI:1740141332
Name:MOGAJI, BISOLA
Entity type:Individual
Prefix:
First Name:BISOLA
Middle Name:
Last Name:MOGAJI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 BRAMBLE WAY
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-4282
Mailing Address - Country:US
Mailing Address - Phone:770-790-7965
Mailing Address - Fax:
Practice Address - Street 1:1313 MILSTEAD AVE NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3829
Practice Address - Country:US
Practice Address - Phone:404-495-7447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-21
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst