Provider Demographics
NPI:1265587869
Name:ADEOGBA, SAINT (MD)
Entity type:Individual
Prefix:DR
First Name:SAINT
Middle Name:
Last Name:ADEOGBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:860 JOHNSON FERRY ROAD
Mailing Address - Street 2:BLD 140, APT 133
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:808-292-3933
Mailing Address - Fax:501-954-8806
Practice Address - Street 1:COMPREHENSIVE WELLNESS CENTER
Practice Address - Street 2:8801 W MARKHAM STREET, SUITE 2
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2343
Practice Address - Country:US
Practice Address - Phone:501-954-8800
Practice Address - Fax:844-205-9825
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA39020000X208D00000X
ARE-89832081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1265587869OtherNPI
AR208292001Medicaid
AR1265587869OtherNPI