Youthfulmd Integrative Health LLC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

YOUTHFULMD INTEGRATIVE HEALTH LLC

Practice address

3105 Creekside Village Dr NW Ste 801
Kennesaw, GA 30144-4218

Phone

(781) 475-2735

NPI assigned

Mar 14, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Ndidiamaka O Obadan, MDNPI 1225385248

Title

Medical Director

Phone

(781) 475-2735

Specialties & licenses 5

Addresses

Other names 1

• YoungerselfMD Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ndidiamaka O Obadan, M.D.,MS

  • Nephrology Physician
  • Kennesaw, GA
  • NPI 1225385248
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1647216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689292800000",
    "number": "1548918196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3105 CREEKSIDE VILLAGE DR NW STE 801",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301444218",
            "telephone_number": "781-475-2735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3105 CREEKSIDE VILLAGE DR NW STE 801",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301444218",
            "telephone_number": "781-475-2735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUTHFULMD INTEGRATIVE HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-14",
        "last_updated": "2023-07-14",
        "certification_date": "2023-07-14",
        "status": "A",
        "authorized_official_last_name": "OBADAN",
        "authorized_official_first_name": "NDIDIAMAKA",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "781-475-2735",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hypertension Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "YoungerselfMD",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "YoungerselfMD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jane Young
• John Michael Young, ATC, LAT
• Kimberly Brooke Young, PMHNP
• Robin K Young, DC
• Sarah Elizabeth Yount, MD
• Tyler Zack
• Samia Alexandria Zahran, MS, CCC-SLP
• Kevin Andrew Zember, PT
• Sherri Ziomek, D.C.
• Emily Zobanov, LPC, LMHC

• Nephrology Physician in Kennesaw, GA
• Providers in Kennesaw, GA by specialty
• Nephrology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.