Provider Demographics
NPI:1164837274
Name:YEBOAH, AKOSUA LYNIQUE (CNA)
Entity Type:Individual
Prefix:MS
First Name:AKOSUA
Middle Name:LYNIQUE
Last Name:YEBOAH
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1048 NOBLE VINES DR APT 4
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-1326
Mailing Address - Country:US
Mailing Address - Phone:404-740-3252
Mailing Address - Fax:
Practice Address - Street 1:1048 NOBLE VINES DR APT 4
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021-1326
Practice Address - Country:US
Practice Address - Phone:404-740-3252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA46-5614639251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health