Olufowobi Gbadebo, MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

054096 Issued in GA

Practice address

116 Hill Pond LN
Statesboro, GA 30458-0872

Phone

(912) 489-1629

NPI assigned

Oct 11, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jun 29, 2015 through Jun 29, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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

• Marshfield Clinic Inc

  • Clinic/Center
  • Marshfield, WI
  • NPI 1952347981
  NPD
• Statesboro Psychiatric Associates

  • Psychiatry Physician
  • Statesboro, GA
  • NPI 1083830400
  NPD (past)

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279756800000",
    "number": "1205924289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 HILL POND LN",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304580872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 HILL POND LN",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304580872",
            "telephone_number": "912-489-1629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GBADEBO",
        "first_name": "OLUFOWOBI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2010-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "46201",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "GA",
            "license": "054096",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "GA",
            "license": "054096",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32497000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cindy O'Bryant Gartmond, M.D.
• Danielle Nicole Gaspard, FNP-BC
• Gastroenterology Institute, PC
• Stephen F. Gay, R.PH.
• Gaynell Denise Hill, LCSW
• John Douglas Geerdes, D'MIN./LMFT
• Julie A Gentile, PTA
• Gentle Hour Wellness
• Georgia Anesthesia and Pain Managment
• Georgia CVS Pharmacy LLC

• Child & Adolescent Psychiatry Physician in Statesboro, GA
• Providers in Statesboro, GA by specialty
• Child & Adolescent Psychiatry Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.