Bolaji T Odusina, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

042380 Issued in GA

Practice address

1155 Lawrenceville Suwanee Rd
Lawrenceville, GA 30043-5425

Phone

(678) 442-0205

Fax

(678) 442-0185

NPI assigned

Apr 28, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: bodusina2909@choa.gadirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Suwanee Pediatrics PC

  • Primary Care Clinic/Center
  • Lawrenceville, GA
  • NPI 1487886123
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335830400000",
    "number": "1306803762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1155 LAWRENCEVILLE SUWANEE RD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300435425",
            "telephone_number": "678-442-0205",
            "fax_number": "678-442-0185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 LAWRENCEVILLE SUWANEE RD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300435425",
            "telephone_number": "678-442-0205",
            "fax_number": "678-442-0185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODUSINA",
        "first_name": "BOLAJI",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-28",
        "last_updated": "2012-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "042380",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Larry R Odom, CRNA
• Adeniyi O Odugbesan, M.D.
• Geraldine Odujole
• Hannah O Odunaiya, MD
• William Ntiamoah Oduro, MD
• Kenneth Onyekwere Ofoha, M.D.
• Laura L Ofoha, FNP-BC
• Gospel Suvwe Ofuyah, CNP
• Chinwe Ogbodo
• Sandra Ifenyinwa Ogbonna

• Pediatrics Physician in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.