Healthcare Provider Details

I. General information

NPI: 1407745219
Provider Name (Legal Business Name): GEORGE ADATSI DHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 NORRIS CANYON RD
SAN RAMON CA
94583-5411
US

IV. Provider business mailing address

153 ARLEN DR
ROHNERT PARK CA
94928-8004
US

V. Phone/Fax

Practice location:
  • Phone: 206-823-1004
  • Fax:
Mailing address:
  • Phone: 517-505-5027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95034620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: