Diana Spock Adebulehin, P.A.-C.

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

004458 Issued in GA

Practice address

1014 Sycamore Dr
Ste. B
Decatur, GA 30030-1644

Phone

(404) 299-1700

Fax

(404) 299-1616

NPI assigned

Nov 6, 2006

Sex

Female

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

Enrolled in GA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/IIEEBD

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.

• Thrive Orthopaedics LLC

  • Orthopaedic Surgery Physician
  • Atlanta, GA
  • NPI 1790386258
  NPD
• Thrive Medical Partners LLC

  • Pain Medicine Physician
  • Gainesville, GA
  • NPI 1144707001
  NPD (past)
• Raleigh Durham Medical Group PA

  • Family Medicine Physician
  • Hillsborough, NC
  • NPI 1194828145
  NPD (past)
• Roxboro Family Medicine & Immediate

  • Family Medicine Physician
  • Roxboro, NC
  • NPI 1619908233
  NPD (past)

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1700965159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 IVY GLEN CIR",
            "city": "AVONDALE ESTATES",
            "state": "GA",
            "postal_code": "300021766",
            "telephone_number": "404-550-5590",
            "fax_number": "404-299-1616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1014 SYCAMORE DR",
            "address_2": "STE. B",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300301644",
            "telephone_number": "404-299-1700",
            "fax_number": "404-299-1616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADEBULEHIN",
        "first_name": "DIANA",
        "middle_name": "SPOCK",
        "name_prefix": "Mrs.",
        "credential": "P.A.-C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-06",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "GA",
            "license": "004458",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maurene Adams, HAIR LOSS SPECIALIST
• Patrice Marie Adams, PMHNP
• Cynthia Addison, RN
• Adetokunboh Monsurundeen Adebayo, MD
• Oladipo Olusoji Adebisi, PHARMD
• Oluwatoyin Adefila
• Toyin Adekunle
• Esther Ibilola Adeyemi, MSN,FNP-C
• Ifeoluwapo Florence Adeyemi
• Olusola Adeyemi

• All providers in Decatur, GA
• Surgical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.