Obatala Ombu, M.A.

Primary specialty

Forensic PsychologistTaxonomy code 103TF0200X

Practice address

209 Short St
Kingstree, SC 29556-3926

Phone

(843) 372-5959

Fax

(843) 355-7746

NPI assigned

Nov 29, 2012

Last updated

Nov 29, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• SC Department of Juvenile Justice

  • Community/Behavioral Health Agency
  • Kingstree, SC
  • NPI 1285988048
  NPD (past)

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

{
    "created_epoch": "1354147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354147200000",
    "number": "1184969347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 697",
            "city": "KINGSTREE",
            "state": "SC",
            "postal_code": "295560697",
            "telephone_number": "843-355-2772",
            "fax_number": "843-355-7746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 SHORT ST",
            "city": "KINGSTREE",
            "state": "SC",
            "postal_code": "295563926",
            "telephone_number": "843-372-5959",
            "fax_number": "843-355-7746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMBU",
        "first_name": "OBATALA",
        "credential": "M.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-11-29",
        "last_updated": "2012-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeaneen R Nelson, MSW
• Next Generation Family and Youth Services LLC
• Nurturing Essentials. LLC
• Ohio Valley Physicians Inc
• Keyatta Oliver
• Mary Veanna Osean, RPH
• Doris Owusu Amoah, DNP, FNP-BC
• Palmetto Primary Care Physicians, LLC
• Pee Dee Foot Center, PA
• Raina McKenzie Philhower, PA-C

• Forensic Psychologist in Kingstree, SC
• Providers in Kingstree, SC by specialty
• Forensic Psychologist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2012; 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.