Active NPI
Moriamo Adedoyin Fashugba, MD
- Internal Medicine Physician
- Valdosta, GA
National Provider Identifier
1033963590
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 16434
- Practice address
- 2501 N Patterson St
Valdosta, GA 31602-1785 - Phone
- (229) 433-1000
- NPI assigned
- Apr 12, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 16434 | GA | Primary |
Addresses
Primary practice location
2501 N Patterson St
Valdosta, GA 31602-1785
Mailing address
2501 N Patterson St
Valdosta, GA 31602-1785
Phone (229) 433-1000
Other names 1
- Dr. Moriamo Adedoyin Jeboda
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16434 | GA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1712880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717113600000",
"number": "1033963590",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2501 N PATTERSON ST",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "316021785",
"telephone_number": "229-433-1000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2501 N PATTERSON ST",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "316021785",
"telephone_number": "229-433-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FASHUGBA",
"first_name": "MORIAMO",
"middle_name": "ADEDOYIN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-04-12",
"last_updated": "2024-05-31",
"certification_date": "2024-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "GA",
"license": "16434",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MORIAMO",
"last_name": "JEBODA",
"middle_name": "ADEDOYIN",
"prefix": "DR.",
"credential": "MD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Valdosta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.