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EBOTE NGITE NNOKO
NPI 1346871696
Nurse Practitioner - Psychiatric/Mental Health in Dallas, GA

Active since January 27, 2020PECOS Enrolled
108 CRESCENT WOODE DR, DALLAS, GA 30157(770) 702-5945 Get Directions Write a Review

NPPES record last updated: January 27, 2020. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Ebote Ngite Nnoko NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EBOTE NGITE NNOKO (NPI 1346871696) is an individual psychiatric/mental health provider in Dallas, Georgia, licensed in Georgia (RN243114) and active in the NPI registry since January 2020. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1346871696
Entity TypeIndividualFemale
Primary Taxonomy363LP0808X
Provider Legal NameEBOTE NGITE NNOKO
Location Address108 CRESCENT WOODE DRDallas, GA 30157-5725
Mailing Address108 Crescent Woode DrDallas, GA 30157-5725 · (770) 702-5945
Phone(770) 702-5945
Sole ProprietorYes
Enumeration DateJanuary 27, 2020
✔ NPI 1346871696 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in GA · RN243114
108 CRESCENT WOODE DR, Dallas, GA 30157
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ebote Ngite Nnoko is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Ebote Nnoko reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Mobolaji Shalom Oyebanjo, Inc
14 mi
Psychiatry
307 OLD STONE RD
Villa Rica, GA 30180
  • Reassigned Medicare billing, Georgia enrollment
  • 10 clinicians in this Medicare group
NPI 1922280684 (770) 459-8799
Lifesource Of North Carolina
36 mi
General Practice
1345 REDMOND CIR NW
Rome, GA 30165
  • Reassigned Medicare billing, Georgia enrollment
  • 92 clinicians in this Medicare group
NPI 1962940817 (910) 742-9243

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30157 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$88.06 typical visit price
range $56.84 – $172.43
Typical copayment $22.01 (range $14.21 – $43.10)
Most-billed visit code 99203
Established Patient
$100.20 typical visit price
range $18.22 – $140.40
Typical copayment $25.05 (range $4.55 – $35.10)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DELIVERANCE HEALTH LIMITED LIABILITY COMPANY
Nurse Practitioner (Psychiatric/Mental Health)
108 CRESCENT WOODE DR
DALLAS, GA 30157
Paulding County (404) 934-6010

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ebote Nnoko's NPI number?

The NPI number for Ebote Nnoko is 1346871696. It was assigned to this individual provider in the NPPES registry on January 27, 2020.

Where is Ebote Nnoko located?

Ebote Nnoko practices at 108 Crescent Woode Dr, Dallas, GA 30157. The listed phone number is (770) 702-5945.

What is Ebote Nnoko's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Ebote Nnoko enrolled in Medicare?

Yes. Ebote Nnoko is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Ebote Nnoko's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Ebote Nnoko reassigns Medicare benefits to 2 organizations: Mobolaji Shalom Oyebanjo, Inc (Villa Rica, GA) and Lifesource Of North Carolina (Rome, GA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Ebote Nnoko's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Ebote Nnoko was last updated on January 27, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.