Liberty Odinamadu Ubani, AGANCP-BC

Primary specialty

Critical Care Medicine (Anesthesiology) PhysicianTaxonomy code 207LC0200X

License

RN221108 Issued in GA

Practice address

1272 Marlton Chase Dr
Lawrenceville, GA 30044-2011

Phone

(404) 966-9572

NPI assigned

Apr 22, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Grady Memorial Hospital Corporation

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1114243813

  Single Specialty

  NPD
• Grady Memorial Hospital Corporation

  • Rehabilitation Hospital
  • Atlanta, GA
  • NPI 1336961119
  NPD

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

{
    "created_epoch": "1619049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702252800000",
    "number": "1386226173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1272 MARLTON CHASE DR",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300442011",
            "telephone_number": "404-966-9572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1272 MARLTON CHASE DR",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300442011",
            "telephone_number": "404-966-9572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UBANI",
        "first_name": "LIBERTY",
        "middle_name": "ODINAMADU",
        "credential": "AGANCP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-22",
        "last_updated": "2023-12-11",
        "certification_date": "2023-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "GA",
            "license": "RN221108",
            "primary": false
        },
        {
            "code": "207LC0200X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Critical Care Medicine",
            "state": "GA",
            "license": "RN221108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexis Tyler
• Robyn Leigh Tynan, PHYSICAL THERAPIST
• Tinisha Tyre
• Sarah Tyser, RN
• Kaitlin Tyson
• Gontse Theodeltia Ugbabe, RN
• Ejovwoke Ughwanogho
• Woojoo Uhn, LCSW
• Uhs of Summitridge, LLC
• Uhs of Summitridge, LLC

• Critical Care Medicine (Anesthesiology) Physician in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Critical Care Medicine (Anesthesiology) Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.