Healthcare Provider Details

I. General information

NPI: 1427154145
Provider Name (Legal Business Name): EMMANUEL O GBADEHAN M.D., FACP, FACG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 S 8TH ST STE 304
GRIFFIN GA
30224-4260
US

IV. Provider business mailing address

619 S 8TH ST STE 304
GRIFFIN GA
30224-4260
US

V. Phone/Fax

Practice location:
  • Phone: 470-267-1680
  • Fax: 470-986-7003
Mailing address:
  • Phone: 470-267-1680
  • Fax: 470-986-7003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number057808
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number56278
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number057808
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number057808
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: