Provider Demographics
NPI:1629239280
Name:ADIBE, JOSEPHINE (NP)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:ADIBE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 BERRYHILL DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-3015
Mailing Address - Country:US
Mailing Address - Phone:404-394-6740
Mailing Address - Fax:404-658-7970
Practice Address - Street 1:55 TRINITY AVE SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3520
Practice Address - Country:US
Practice Address - Phone:404-865-8497
Practice Address - Fax:404-658-7970
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN111866363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner