Olumide Edemodu, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-13-14409

Practice address

2788 Defoors Ferry Rd NW
Atlanta, GA 30318-2182

Phone

(646) 251-0799

NPI assigned

Aug 12, 2014

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

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

{
    "created_epoch": "1407801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1689083867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2788 DEFOORS FERRY RD NW APT 85",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303182150",
            "telephone_number": "646-251-0799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2788 DEFOORS FERRY RD NW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303182182",
            "telephone_number": "646-251-0799"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "147 E Olive Ave",
            "address_purpose": "LOCATION",
            "city": "Monrovia",
            "state": "CA",
            "postal_code": "910163407",
            "country_code": "US",
            "telephone_number": "866-727-8274",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "147 E Olive Ave",
            "address_purpose": "LOCATION",
            "city": "Monrovia",
            "state": "CA",
            "postal_code": "910163407",
            "country_code": "US",
            "telephone_number": "866-727-8274",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EDEMODU",
        "first_name": "OLUMIDE",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-12",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": "1-13-14409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaitlin Kelly Eddy, PA
• Destine Ede, MD
• Scott Edelman
• Sheila C Edelson
• Bruce Alan Edelstein, D.D.S.
• Eden Pharmacy LLC
• Claire Cutler Eden, IBCLC
• Eden'S Care Hospice, LLC Dba Eden'S Care
• Eden'S Home of Care, LLC
• Jane Jones Edens, RN

• Behavior Analyst in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Behavior Analyst in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.

Verify at the official NPI Registry.