FARAH OCTAVIEN (AGNP) – Gerontology Clinical Nurse Specialist, NPI 1629629613

Gerontology Clinical Nurse Specialist

FARAH OCTAVIEN (AGNP) is a healthcare provider. based in Ellenwood, Georgia. specializing in Gerontology Clinical Nurse Specialist. They hold the professional credentials AGNP. They hold a License No. AG03190021 (GA). The NPI Number for FARAH OCTAVIEN (AGNP) is 1629629613

Main info

Female

Sole Proprietor

9 Years Of Experience

Accepts Medicare Assignment

Name

FARAH OCTAVIEN (AGNP)

NPI

1629629613

Phone

(678) 571-0918

Address

2873 VILLAGE PARK DR E

Enumeration Date

22 September 2019

Last Update Date

22 September 2019

Doctor Profile

Medical School Name

OTHER

Secondary Phone

8887720076

Graduation Year

2017 (9 years ago)

PAC ID

2567898067

Group Practice PAC ID

4486895083

Professional Enrollment ID

I20200131000773

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience26

Completeness75

Years active:6State licenses:1Digital endpointsOther names

Provider Addresses for FARAH OCTAVIEN (AGNP)

2873 VILLAGE PARK DR E
ELLENWOOD, GA 302945712
Phone: (678) 571-0918
Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

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

No Medicare enrollment or revalidation data available for this provider in our database.

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 30294)

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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: 4486895083View full group profile

Name	Specialty	State
ROBERTA ANNE WALTERS (APRN)	-	GA
EMILY ELIZABETH ADAMS (NP-C)	-	GA
DR. DIANA KHARBAT SODIQ (D.O.)	-	GA
MYRNA GACUSAN	-	GA
BOLANLE OLAYINKA BABAJIDE-GBENGA (PMHNP)	-	GA
MRS. FRANTORIA SHUNZETTE WELCH (FNP)	-	GA
FAIZAN SHAIKH (M.D.)	-	GA
DR. THOMAS JR. MATHEW (M.D.)	-	GA
CHARLOTTE DAVID (FNP, BSN, RN)	-	GA
REBECCA CAMPBELL HENDERSON (MSN, FNP-C)	-	GA

Reviews

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Frequently asked questions

What federal number belongs to FARAH OCTAVIEN (AGNP)?

The federal identifier for FARAH OCTAVIEN (AGNP) is NPI 1629629613.

Does this profile mean FARAH OCTAVIEN (AGNP) is currently active?

Yes — FARAH OCTAVIEN (AGNP) appears active in the national provider directory.

Does FARAH OCTAVIEN (AGNP) list a primary specialty?

If you are matching referrals, note Gerontology Clinical Nurse Specialist for FARAH OCTAVIEN (AGNP). Clinical services aligned with this taxonomy classification.

Where is FARAH OCTAVIEN (AGNP)'s primary listing?

We display Ellenwood, Georgia because that is what the record indicates for FARAH OCTAVIEN (AGNP).

Does Medicare enrollment show here?

Medicare enrollment screens are separate from the basic NPI extract shown here.