Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | RN181677 | GA |
NPI | 1063803260 |
---|---|
Provider Name | Mavis Nyarko Yeboah |
First Address | Acworth, GA 30102-2038 |
Second Address | Acworth, GA 30102-2038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2015 |
Last Update Date | 23/08/2016 |