Kola Ologunja

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

050548 Issued in GA

Practice address

3104 Creekside Village Dr NW
Suite 504
Kennesaw, GA 30144-2358

Phone

(770) 966-0778

NPI assigned

Jul 26, 2005

Last updated

May 19, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• Spectrum Pediatric GRP

  • Medical Specialty Clinic/Center
  • Kennesaw, GA
  • NPI 1154447043
  NPD (past) Authorized official

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

{
    "created_epoch": "1122336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211155200000",
    "number": "1649270158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3104 CREEKSIDE VILLAGE DR NW",
            "address_2": "SUITE 504",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301442324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3104 CREEKSIDE VILLAGE DR NW",
            "address_2": "SUITE 504",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301442358",
            "telephone_number": "770-966-0778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLOGUNJA",
        "first_name": "KOLA",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-26",
        "last_updated": "2008-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "050548",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "855356",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000972408G",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bose Oyronke Olaniyi-Adeyemo
• Damilola Olarenwaju, RN
• Morgan Marie Olds, P.T.A
• Tami C Oliver, RPH
• Lynda Garner Olle
• David Eric Olson, D.M.D.
• Omega Family Dentistry
• Omega Physician Practice LLC
• Omnia Therapy Solutions LLC
• Miranda Omoregie

• Pediatrics Physician in Kennesaw, GA
• Providers in Kennesaw, 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 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.