Active NPI
Vivian Chinonyelum Umegbolu, PHARMD
- Pharmacist
- Valdosta, GA
National Provider Identifier
1770189888
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 031022
- Practice address
- 2205 N Ashley St
Valdosta, GA 31602-2612 - Phone
- (229) 333-0222
- NPI assigned
- Dec 5, 2020
- Last updated
- Nov 7, 2022
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 031022 | GA | Primary |
Addresses
Primary practice location
2205 N Ashley St
Valdosta, GA 31602-2612
Mailing address
2205 N Ashley St
Valdosta, GA 31602-2612
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)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 031022 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Georgia CVS Pharmacy, L.L.C. | Past | Accepting new patients | |
| Georgia CVS Pharmacy L.L.C | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667779200000",
"number": "1770189888",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2205 N ASHLEY ST",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "316022612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2205 N ASHLEY ST",
"city": "VALDOSTA",
"state": "GA",
"postal_code": "316022612",
"telephone_number": "229-333-0222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UMEGBOLU",
"first_name": "VIVIAN",
"middle_name": "CHINONYELUM",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-12-05",
"last_updated": "2022-11-07",
"certification_date": "2022-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "031022",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Valdosta, GA
- Lashannon Turner, MSW
- Mallory Sims Tyre, LMFT
- Suzanne C Tyrone, CRNA
- Julie Tyus, OT
- Shawn E Tywon, PA
- Jonathan Lance Underwood, MD
- Unihealth Solutions, Inc. (UniHealth Solutions of Valdosta)
- United Rehab Inc (United Rehab of Holly Hill)
- United Rehab Inc. (United Rehab of Crestwood)
- United Rehab Inc. (United Rehab of Lakehaven)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.