Provider Demographics
NPI:1902520364
Name:ABOLARIN, JAMES AGBO
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:AGBO
Last Name:ABOLARIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 VININGS SPRINGS DR SE
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-5995
Mailing Address - Country:US
Mailing Address - Phone:404-429-7173
Mailing Address - Fax:
Practice Address - Street 1:580 VININGS SPRINGS DR SE
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-5995
Practice Address - Country:US
Practice Address - Phone:404-429-7173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty