OMOTAYO OMOSEBI ABDUL (PMHNP) – Psychiatric/Mental Health Nurse Practitioner, NPI 1417623984

OMOTAYO OMOSEBI ABDUL (PMHNP) is a healthcare provider. based in Jonesboro, Georgia. specializing in NURSE PRACTITIONER. They hold the professional credentials PMHNP. They hold a License No. RN114603 (GA). The NPI Number for OMOTAYO OMOSEBI ABDUL (PMHNP) is 1417623984

Main info

Female
Sole Proprietor
12 Years Of Experience
Accepts Medicare Assignment
Name
OMOTAYO OMOSEBI ABDUL (PMHNP)
NPI
1417623984
Phone
(404) 567-3262
Address
7772 THRAILKILL RD
Enumeration Date
17 August 2021
Last Update Date
6 January 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7709548685
Graduation Year
2014 (12 years ago)
PAC ID
0749671477
Group Practice PAC ID
5092611384
Professional Enrollment ID
I20220106001316
Address ID
GA302816388ST250XXCTXX400
Telehealth
Yes

Contacts

Other Endpoint
Morrow
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience46
Completeness95
Years active:4State licenses:2Other names

9,652 NURSE PRACTITIONER in GA

Provider Addresses for OMOTAYO OMOSEBI ABDUL (PMHNP)

  • 7772 THRAILKILL RD

    JONESBORO, GA 302362459

    Phone: (404) 567-3262

    Type: Mailing

  • 1401 PEACHTREE ST NE STE 110

    ATLANTA, GA 303093005

    Phone: (470) 749-3520

    Fax: (470) 378-1997

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 5 Open Payments records for all available years, with a total value of $164.

Total Amount is formed as General ($164) + Research ($0) + Ownership ($0) = $164.

Last reported payment date: 2024-10-09 • Largest payer in this snapshot: ABBVIE INC. ($146).

Total Amount

$164

General + Research + Ownership

Payments

5

Total payment records

General Amount

$164

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-10-09

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
ABBVIE INC.$146
Novo Nordisk Inc$18
View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2022-01-06

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20220106001316INurse PractitionerGATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 30236)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 5092611384View full group profile
NameSpecialtyState
Nurse PractitionerGA
Nurse PractitionerFL
-GA
-GA
Clinical PsychologistGA
Nurse PractitionerGA
Clinical PsychologistGA
Marriage And Family TherapistGA
P S Y C H I A T R YGA
Clinical PsychologistGA

Reviews

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Frequently asked questions

What unique ID ties claims to OMOTAYO OMOSEBI ABDUL (PMHNP)?
NPI 1417623984 is assigned to OMOTAYO OMOSEBI ABDUL (PMHNP) under the national enumeration system.
Is OMOTAYO OMOSEBI ABDUL (PMHNP)'s enrollment marked active?
An active flag here means the NPI record is not in a deactivated state.
What does OMOTAYO OMOSEBI ABDUL (PMHNP) treat or focus on?
Patients typically see OMOTAYO OMOSEBI ABDUL (PMHNP) under the specialty Psychiatric/Mental Health Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Where does public data place OMOTAYO OMOSEBI ABDUL (PMHNP)?
The snapshot lists Jonesboro, Georgia for OMOTAYO OMOSEBI ABDUL (PMHNP); download NPPES for the complete set.
Is this NPI for an individual or an organization?
This listing corresponds to an Individual Provider.

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