OLUFOWOBI GBADEBO MD NPI 1205924289

NPI Information

  • NPI: 1205924289
  • Provider Name: OLUFOWOBI GBADEBO, MD
  • Classification: Psychiatry & Neurology - 2084P0804X
  • Specialization: Child & Adolescent Psychiatry
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 116 HILL POND LN
    STATESBORO, GA
    ZIP 30458
  • Phone: (912) 489-1629

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NPI Details

Olufowobi Gbadebo, MD is a child and adolescent psychiatry psychiatry neurology in Statesboro, GA. The provider is child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. Olufowobi Gbadebo, MD NPI is 1205924289. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

116 HILL POND LN
STATESBORO, GA
ZIP 30458-872
Phone: (912) 489-1629

The NPI 1205924289 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/11/2006 and was last updated on 7/22/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatrics46201WISCONSINNo
22084P0800XPsychiatry & NeurologyPsychiatry054096GEORGIANo
32084P0804XPsychiatry & NeurologyChild & Adolescent Psychiatry054096GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1G86060MEDICARE UPIN
232497000MEDICAIDWISCONSIN
3020020270MEDICARE ID-TYPE UNSPECIFIEDWISCONSIN
4064372200MEDICARE PINWISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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