Glory Osadiaye, PMHNP, MSN, BSN, RN
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Lawrenceville, GA
NPI 1003490764 · NPPES record last updated Jun 11, 2023
Key facts
- NPI
- 1003490764
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 250999 (GA)
- Practice address
- 250 Constitution Blvd
Lawrenceville, GA 30046-8432 - Phone
- (470) 844-0157
- Fax
- (678) 539-8899
- NPI assigned
- May 10, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
368 W Pike St
Suite 103B
Lawrenceville, GA 30046-3240
Phone (470) 844-0157
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221109002437 | GA | Practitioner - Nurse Practitioner | 7517334295 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Bachelor on Science - Nursing, Master of Science - Nursing, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN250999 | GA | MD | Home Health Registered Nurse |
| 250999 | GA | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Inner Community Health | Current |
Accepting new patients | |
| Grow Healthcare Group PA | Psychiatric/Mental Health | Current |
Accepting new patients |
| Gentlecare LLC | Current |
Accepting new patients |
Locations
66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711
715 Peachtree St NE
Ste 100
Atlanta, GA 30308
Phone (202) 972-4964
2180 Satellite Blvd
Ste 400
Duluth, GA 30097
Phone (770) 256-3765
10700 Medlock Bridge Rd
Ste 104
Johns Creek, GA 30097
Phone (770) 476-9885
250 Constitution Blvd
Lawrenceville, GA 30046
Phone (470) 844-0157
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN250999 | GA | |
| Home Health Registered Nurse | 163WH0200X | RN250999 | GA | |
| Hospice Registered Nurse | 163WH1000X | RN250999 | GA | |
| Medical-Surgical Registered Nurse | 163WM0705X | RN250999 | GA | |
| Psychiatric/Mental Health Registered Nurse | 163WP0808X | RN250999 | GA | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | RN250999 | GA | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 250999 | GA | Yes |
Addresses
Primary practice location
250 Constitution Blvd
Lawrenceville, GA 30046-8432
Mailing address
250 Constitution Blvd
Lawrenceville, GA 30046-8432
Phone (470) 844-0157
Other providers in Lawrenceville, GA
- Orthopedic Surgery, P.C.
- Johana Medina Ortiz
- Margaret Ortiz
- Emil Orza
- Verena Orzikowski
- Amimi Sandra Osayande
- Carol Ann Osbaldeston
- Marshelia Osborne
- Sean Osborne
- Samson Ebho Osebor
All providers in Lawrenceville, GA · Psychiatric/Mental Health Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 11, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.