Provider Demographics
NPI:1609107721
Name:BOLAJI, DORCAS (APRN)
Entity type:Individual
Prefix:MRS
First Name:DORCAS
Middle Name:
Last Name:BOLAJI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 TOFT AVENUE
Mailing Address - Street 2:GRAYS,
Mailing Address - City:ESSEX
Mailing Address - State:UK
Mailing Address - Zip Code:RM17 5SP
Mailing Address - Country:GB
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1231 SWEETGUM TRL
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3593
Practice Address - Country:US
Practice Address - Phone:678-907-2089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN185697163WP0809X
FL11027248363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult