Provider Demographics
NPI:1871607226
Name:OGUNSAKIN, MOBOLAJI O SR (MD)
Entity type:Individual
Prefix:DR
First Name:MOBOLAJI
Middle Name:O
Last Name:OGUNSAKIN
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 WATSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3446
Mailing Address - Country:US
Mailing Address - Phone:478-922-5122
Mailing Address - Fax:478-922-5221
Practice Address - Street 1:1420 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3446
Practice Address - Country:US
Practice Address - Phone:478-922-5122
Practice Address - Fax:478-922-5221
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055136207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA721242214AMedicaid
GAG56559Medicare UPIN
GA721242214AMedicaid