NPIMap

Individual provider Active NPI

Grace Oghale Osiezagha

  • Home Health Agency
  • Lithonia, GA
National Provider Identifier
1053894618
Registry record updated Sep 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Practice address
5549 McCrossin Cir
Lithonia, GA 30038-4801
Phone
(404) 917-5112
Fax
(770) 323-7512
NPI assigned
Sep 10, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 10, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior TechnicianGroup: 193400000X SINGLE SPECIALTY GROUP 106S00000X GA
Community Health Worker 172V00000X GA
Health Educator 174H00000X GA
Peer Specialist 175T00000X GA
Community/Behavioral Health Agency 251S00000X GA
Home Health Agency 251E00000X GA Primary

Addresses

Primary practice location

5549 McCrossin Cir
Lithonia, GA 30038-4801

Mailing address

5549 McCrossin Cir
Lithonia, GA 30038-4801
Phone (404) 917-5112

Other identifiers 4

IdentifierTypeStateIssuer
1066260OtherGAHEALTH EDUCATION
CN0028834263OtherGACNA
886674697OtherGANASW
263534OtherGABFTS

Other names 1

  • Grace Oghale Gordon Other name

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1536537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536537600000",
    "number": "1053894618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5549 MCCROSSIN CIR",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300384801",
            "telephone_number": "404-917-5112",
            "fax_number": "770-323-7512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5549 MCCROSSIN CIR",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300384801",
            "telephone_number": "404-917-5112",
            "fax_number": "770-323-7512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OSIEZAGHA",
        "first_name": "GRACE",
        "middle_name": "OGHALE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-10",
        "last_updated": "2018-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Technician",
            "state": "GA",
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "GA",
            "license": null,
            "primary": false
        },
        {
            "code": "174H00000X",
            "taxonomy_group": "",
            "desc": "Health Educator",
            "state": "GA",
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "GA",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH EDUCATION",
            "identifier": "1066260",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CNA",
            "identifier": "CN0028834263",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NASW",
            "identifier": "886674697",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BFTS",
            "identifier": "263534",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GRACE",
            "last_name": "GORDON",
            "middle_name": "OGHALE",
            "credential": "HEALTH EDUCATOR M.ED",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lithonia, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.