Amanu Physical Medicine & Rehabilitation, LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

AMANU PHYSICAL MEDICINE & REHABILITATION, LLC

Practice address

2101 Newnan Crossing Blvd E
Newnan, GA 30265-2406

Phone

(812) 272-4497

Fax

(419) 828-8218

NPI assigned

May 12, 2006

Organization subpart

No

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

Authorized official

Name

Ismailu O Agbaje, PHD MDNPI 1336190776

Title

Owner

Phone

(812) 272-4497

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ismailu O Agbaje, PHD MD

  • Physical Medicine & Rehabilitation Physician
  • Newnan, GA
  • NPI 1336190776
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602115200000",
    "number": "1891746228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 73200",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302713200",
            "telephone_number": "812-272-4497",
            "fax_number": "419-828-8218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 NEWNAN CROSSING BLVD E",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302652406",
            "telephone_number": "812-272-4497",
            "fax_number": "419-828-8218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMANU PHYSICAL MEDICINE & REHABILITATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2020-10-08",
        "certification_date": "2020-10-08",
        "status": "A",
        "authorized_official_last_name": "AGBAJE",
        "authorized_official_first_name": "ISMAILU",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-272-4497",
        "authorized_official_credential": "PHD MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "WV",
            "license": "23966",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Medicine & Rehabilitation Physician in Newnan, GA
• Providers in Newnan, GA by specialty
• Physical Medicine & Rehabilitation Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.