YOUNGERSELFMD
NPI 1548918196
Internal Medicine - Nephrology in Kennesaw, GA

Q: What is Youthfulmd Integrative Health LLC's NPI number?

The NPI number for Youthfulmd Integrative Health LLC is 1548918196. It was assigned to this organization in the NPPES registry on March 14, 2022. The provider is doing business as Youngerselfmd.

Q: What is Youthfulmd Integrative Health LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Nephrology, with taxonomy code 207RN0300X.

Active since March 14, 2022CLIA 11D2256255 · Waiver

3105 CREEKSIDE VILLAGE DR NW STE 801, KENNESAW, GA 30144(781) 475-2735 Get Directions Write a Review

NPPES record last updated: July 14, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 14, 2023, Oct 31, 2022 (2 updates tracked since 2022).

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About Youngerselfmd NPPES

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

YOUNGERSELFMD (NPI 1548918196) is a healthcare organization registered as a nephrology in Kennesaw, Georgia and active in the NPI registry since March 2022. The organization holds a CLIA Waiver certificate valid through March 21, 2028 and lists Ndidiamaka O Obadan, Medical Director, as its authorized official.

NPPES Registry Identity

NPI1548918196

Entity TypeOrganization

Primary Taxonomy207RN0300X

Legal Business NameYOUTHFULMD INTEGRATIVE HEALTH LLC

Location Address3105 CREEKSIDE VILLAGE DR NW STE 801Kennesaw, GA 30144-4218

Mailing Address3105 Creekside Village Dr Nw Ste 801Kennesaw, GA 30144-4218 · (781) 475-2735

Phone(781) 475-2735

Organization SubpartNo

Authorized OfficialNdidiamaka O ObadanMedical Director · (781) 475-2735

Enumeration DateMarch 14, 2022

Last NPPES UpdateJuly 14, 20232 updates tracked since enumeration

NPPES CertifiedJuly 14, 2023

✔ NPI 1548918196 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 5

★ Primary SpecialtyInternal Medicine · NephrologyAllopathic & Osteopathic Physicians

Taxonomy Code207RN0300X

Definition

An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.

Also ListedInternal MedicineTaxonomy 207R00000X

Also ListedInternal Medicine · Hypertension SpecialistTaxonomy 207RH0005X

Also ListedInternal Medicine · Infectious DiseaseTaxonomy 207RI0200X

Also ListedHospitalistTaxonomy 208M00000X

3105 CREEKSIDE VILLAGE DR NW STE 801, Kennesaw, GA 30144

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Other Names 1

Doing Business AsYoungerselfmd

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

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

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Youngerselfmd, which bills Medicare for the services this clinician delivers.

Clinician (1)

Ndidiamaka Obadan, M.D.,MS

Internal Medicine

NPI 1225385248

3105 CREEKSIDE VILLAGE DR NW STE 801
Kennesaw, GA 30144

(404) 566-4623

✔ PECOS✔ Accepts MedicareSame address

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

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D2256255

Youngerselfmd · Kennesaw, GA

Active · expires Mar 21, 2028

CLIA Number11D2256255

Laboratory TypePhysician Office

Certificate Effective DateMarch 22, 2026

Certificate Expiration DateMarch 21, 2028

Laboratory DirectorNdidiamaka O. Obadan

Laboratory Phone(404) 566-4623

Laboratory LocationYoungerselfmd3105 Creekside Village Drive NW, #801, Kennesaw, GA 30144

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

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 Youthfulmd Integrative Health LLC's NPI number?

The NPI number for Youthfulmd Integrative Health LLC is 1548918196. It was assigned to this organization in the NPPES registry on March 14, 2022. The provider is doing business as Youngerselfmd.

Where is Youthfulmd Integrative Health LLC located?

Youthfulmd Integrative Health LLC is located at 3105 Creekside Village Dr NW Ste 801, Kennesaw, GA 30144. The listed phone number is (781) 475-2735.

What is Youthfulmd Integrative Health LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Nephrology, with taxonomy code 207RN0300X.

Is Youthfulmd Integrative Health LLC enrolled in Medicare?

Yes. Youthfulmd Integrative Health LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Youthfulmd Integrative Health LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Youthfulmd Integrative Health LLC. A 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 the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Youthfulmd Integrative Health LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2256255) is associated with this NPI, valid through March 21, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Youthfulmd Integrative Health LLC was last updated on July 14, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.