Provider Demographics
NPI:1427154145
Name:GBADEHAN, EMMANUEL O (MD, FACP, FACG)
Entity type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:O
Last Name:GBADEHAN
Suffix:
Gender:M
Credentials:MD, FACP, FACG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 S 8TH ST STE 304
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4260
Mailing Address - Country:US
Mailing Address - Phone:470-267-1680
Mailing Address - Fax:470-986-7003
Practice Address - Street 1:619 S 8TH ST STE 304
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4260
Practice Address - Country:US
Practice Address - Phone:470-267-1680
Practice Address - Fax:470-986-7003
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057808207R00000X, 207RI0008X, 207RG0100X
KY56278207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA747209086DMedicaid
GA747209086EMedicaid
GAGRP7927Medicare UPIN