THE POTTER BEHAVIORAL MEDICINE CLINIC
NPI 1922280684
Psychiatry & Neurology - Psychiatry in Villa Rica, GA

Q: What is Mobolaji Shalom Oyebanjo, Inc's NPI number?

The NPI number for Mobolaji Shalom Oyebanjo, Inc is 1922280684. It was assigned to this organization in the NPPES registry on December 4, 2007. The provider is doing business as The Potter Behavioral Medicine Clinic.

Q: What is Mobolaji Shalom Oyebanjo, Inc's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Psychiatry, with taxonomy code 2084P0800X.

Active since December 04, 2007

307 OLD STONE RD, VILLA RICA, GA 30180(770) 459-8799(770) 459-8919 Get Directions Write a Review

NPPES record last updated: October 3, 2012. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About The Potter Behavioral Medicine Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

THE POTTER BEHAVIORAL MEDICINE CLINIC (NPI 1922280684) is a healthcare organization registered as a psychiatry in Villa Rica, Georgia and active in the NPI registry since December 2007. The organization lists Mobolaji Oyebanjo, Provider, as its authorized official.

NPPES Registry Identity

NPI1922280684

Entity TypeOrganization

Primary Taxonomy2084P0800X

Legal Business NameMOBOLAJI SHALOM OYEBANJO, INC

Location Address307 OLD STONE RDVilla Rica, GA 30180-1214

Mailing Address307 Old Stone RdVilla Rica, GA 30180-1214 · (770) 459-8799 · Fax (770) 459-8919

Phone(770) 459-8799

Fax(770) 459-8919

Organization SubpartNo

Authorized OfficialMobolaji OyebanjoProvider · (770) 459-8799

Enumeration DateDecember 4, 2007

Last NPPES UpdateOctober 3, 2012

✔ NPI 1922280684 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyPsychiatry & Neurology · PsychiatryAllopathic & Osteopathic Physicians

Taxonomy Code2084P0800X

Definition

A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems.

Also ListedFamily MedicineTaxonomy 207Q00000X

Also ListedPsychiatry & Neurology · Addiction PsychiatryTaxonomy 2084P0802X

Also ListedClinic/Center · Mental Health (Including Community Mental Health Center)Taxonomy 261QM0801X

307 OLD STONE RD, Villa Rica, GA 30180

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Other Names 1

Doing Business AsThe Potter Behavioral Medicine Clinic

Other Identifiers 4

Medicare PIN511G700335GA

Medicaid327161185BGA

Medicare PIN26BDKGPGA

Medicaid327161185AGA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter Health, Ambetter of Alabama and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

The Potter Behavioral Medicine Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 10 clinicians reassign Medicare billing to The Potter Behavioral Medicine Clinic, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians by Medicare Specialty 4

Nurse Practitioner7

Addiction Medicine1

Physician Assistant1

Psychiatry1

Clinicians, nearest first (10)

Jason Fordyce, PMHNP-BC

Nurse Practitioner

NPI 1346816865

307 OLD STONE RD
Villa Rica, GA 30180

(770) 459-8799

✔ PECOSSame address

Omobolaji Oyebanjo Popoola, MD

Psychiatry

NPI 1578754503

307 OLD STONE RD
Villa Rica, GA 30180

(770) 459-8799

✔ PECOSSame address

Ebote Nnoko

Nurse Practitioner

NPI 1346871696

108 CRESCENT WOODE DR
Dallas, GA 30157

(770) 702-5945

✔ PECOS14 mi

Meredith Meece, NP-C

Nurse Practitioner

NPI 1306250121

122 N MORNINGSIDE DR
Cartersville, GA 30121

(678) 723-6721

✔ PECOS✔ Accepts Medicare30 mi

Chaska Moore, PA-C

Physician Assistant

NPI 1932305810

750 MOUNT ZION RD
Jonesboro, GA 30236

(770) 960-8855

✔ PECOS✔ Accepts Medicare34 mi

Louise Wise, DNP, PMHNP-BC

Nurse Practitioner

NPI 1851782965

2206 HANFRED LN STE 103
Tucker, GA 30084

(678) 831-6429

✔ PECOS41 mi

Ebony Cameron, PMHNP

Nurse Practitioner

NPI 1255924577

345 MANGO CT
Mcdonough, GA 30253

(404) 488-4464

✔ PECOS✔ Accepts Medicare45 mi

Regina Ayeni, NP

Nurse Practitioner

NPI 1720375165

1199 PRINCE AVE
Athens, GA 30606

(478) 464-8134

✔ PECOS✔ Accepts Medicare89 mi

Sabo Uba, NP

Nurse Practitioner

NPI 1508106873

2017 JEFFERSON ST SW
Roanoke, VA 24014

(540) 981-8025

✔ PECOS✔ Accepts Medicare370 mi

Samuel Fadare, MD

Addiction Medicine

NPI 1184685802

5604 NE ANTIOCH RD
Gladstone, MO 64119

(660) 372-1313

✔ PECOS✔ Accepts Medicare655 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mobolaji Shalom Oyebanjo, Inc's NPI number?

The NPI number for Mobolaji Shalom Oyebanjo, Inc is 1922280684. It was assigned to this organization in the NPPES registry on December 4, 2007. The provider is doing business as The Potter Behavioral Medicine Clinic.

Where is Mobolaji Shalom Oyebanjo, Inc located?

Mobolaji Shalom Oyebanjo, Inc is located at 307 Old Stone Rd, Villa Rica, GA 30180. The listed phone number is (770) 459-8799.

What is Mobolaji Shalom Oyebanjo, Inc's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Psychiatry, with taxonomy code 2084P0800X.

Is Mobolaji Shalom Oyebanjo, Inc enrolled in Medicare?

Yes. Mobolaji Shalom Oyebanjo, Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Mobolaji Shalom Oyebanjo, Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 10 clinicians in 4 Medicare specialties reassign their Medicare billing to Mobolaji Shalom Oyebanjo, Inc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (7), Addiction Medicine (1) and Physician Assistant (1). Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Mobolaji Shalom Oyebanjo, Inc accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Mobolaji Shalom Oyebanjo, Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Mobolaji Shalom Oyebanjo, Inc was last updated on October 3, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.