Provider Demographics
NPI:1023182748
Name:OWUSU, JACQUELINE AKUA (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:AKUA
Last Name:OWUSU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5035 HAWKS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-2043
Mailing Address - Country:US
Mailing Address - Phone:917-319-5411
Mailing Address - Fax:706-507-9408
Practice Address - Street 1:2022 10TH AVE STE B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3720
Practice Address - Country:US
Practice Address - Phone:706-507-9407
Practice Address - Fax:706-507-9408
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055870207P00000X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA280803795JMedicaid
GAGRP4787OtherMEDICARE PTAN HOSPITALIST OF DUBLIN
GA055870OtherGA STATE LICENSE
GA05390548OtherAMERIGROUP
GA11674408OtherCAQH
GA280803795AMedicaid
GA1539774OtherWELLCARE