Active NPI
Titi A Ipadeola
- Professional Counselor
- Jonesboro, GA
National Provider Identifier
1366949968
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 004963
- Practice address
- 205 N Main St
Jonesboro, GA 30236-3224 - Phone
- (770) 865-9118
- NPI assigned
- Apr 10, 2018
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 004963 | GA | Primary |
Addresses
Primary practice location
205 N Main St
Jonesboro, GA 30236-3224
Mailing address
PO Box 1245
Stockbridge, GA 30281-8245
Phone (770) 865-9118
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 034664765 | Other | GA | DRIVER'S LICENSE |
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1523318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1523318400000",
"number": "1366949968",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1245",
"city": "STOCKBRIDGE",
"state": "GA",
"postal_code": "302818245",
"telephone_number": "770-865-9118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 N MAIN ST",
"city": "JONESBORO",
"state": "GA",
"postal_code": "302363224",
"telephone_number": "770-865-9118"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IPADEOLA",
"first_name": "TITI",
"middle_name": "A",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-04-10",
"last_updated": "2018-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "004963",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DRIVER'S LICENSE",
"identifier": "034664765",
"state": "GA"
}
],
"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 Apr 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.