Active NPI
Boyede Franklin Ademodi, M.D
- Adult Medicine Physician
- Jonesboro, GA
National Provider Identifier
1043343387
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Medicine Physician
- License
- 58385
- Practice address
- 2400 Mount Zion Pkwy
Department of Internal Medicine
Jonesboro, GA 30236-2500 - Phone
- (770) 603-3667
- NPI assigned
- Mar 14, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Adult Medicine Physician | 207QA0505X | 58385 | GA | Primary |
Addresses
Primary practice location
2400 Mount Zion Pkwy
Department of Internal Medicine
Jonesboro, GA 30236-2500
Mailing address
3495 Piedmont Rd NE
Nine Piedmont Center
Atlanta, GA 30305-1773
Phone (404) 364-7000
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 |
|---|---|---|---|
| 58385 | GA | MD | Adult Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1043343387",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3495 PIEDMONT RD NE",
"address_2": "NINE PIEDMONT CENTER",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303051773",
"telephone_number": "404-364-7000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 MOUNT ZION PKWY",
"address_2": "DEPARTMENT OF INTERNAL MEDICINE",
"city": "JONESBORO",
"state": "GA",
"postal_code": "302362500",
"telephone_number": "770-603-3667"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ADEMODI",
"first_name": "BOYEDE",
"middle_name": "FRANKLIN",
"credential": "M.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207QA0505X",
"taxonomy_group": "",
"desc": "Family Medicine, Adult Medicine",
"state": "GA",
"license": "58385",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jonesboro, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.