Individual provider Active NPI

Otobong Isidore Udoudoh, NP

  • Pediatric Nurse Practitioner
  • Atlanta, GA
National Provider Identifier
1902272107
Registry record updated Oct 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
RN186691 Issued in GA
Practice address
1001 Johnson Fy Rd NE
Atlanta, GA 30342-1605
Phone
(404) 785-5050
NPI assigned
Aug 11, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X RN186691 GA Primary

Addresses

Primary practice location

1001 Johnson Fy Rd NE
Atlanta, GA 30342-1605

Mailing address

5901-B Peachtree Dunwoody Rd, NE
Ste B420
Atlanta, GA 30328

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20241231003066 GA Practitioner - Nurse Practitioner 2961939038 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN186691GAMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Columbus Ambulatory Healthcare Services, Inc. CurrentSince Sep 1, 2024 Accepting new patients
Columbus Ambulatory Healthcare Services, Inc. CurrentSince Sep 1, 2024 Accepting new patients

Locations

1800 10th Ave
Columbus, GA 31901
Phone (706) 571-1120

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1439251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759968000000",
    "number": "1902272107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5901-B PEACHTREE DUNWOODY RD, NE",
            "address_2": "STE B420",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 JOHNSON FY RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421605",
            "telephone_number": "404-785-5050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UDOUDOH",
        "first_name": "OTOBONG",
        "middle_name": "ISIDORE",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-08-11",
        "last_updated": "2025-10-09",
        "certification_date": "2025-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "GA",
            "license": "RN186691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.