1265587869 NPI number — DR. SAINT ADEOGBA M.D.

Table of content: DR. SAINT ADEOGBA M.D. (NPI 1265587869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265587869 NPI number — DR. SAINT ADEOGBA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADEOGBA
Provider First Name:
SAINT
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265587869
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
860 JOHNSON FERRY ROAD
Provider Second Line Business Mailing Address:
BLD 140, APT 133
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-292-3933
Provider Business Mailing Address Fax Number:
501-954-8806

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COMPREHENSIVE WELLNESS CENTER
Provider Second Line Business Practice Location Address:
8801 W MARKHAM STREET, SUITE 2
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72205-2343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-954-8800
Provider Business Practice Location Address Fax Number:
844-205-9825
Provider Enumeration Date:
01/24/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  39020000X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P2900X , with the licence number: E-8983 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1265587869 . This is a "NPI" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 208292001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".