Provider Demographics
NPI:1225368749
Name:FOBUZIE, LEONIE NTSAH
Entity Type:Individual
Prefix:
First Name:LEONIE
Middle Name:NTSAH
Last Name:FOBUZIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 HERITAGE PARK TRCE NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-4832
Mailing Address - Country:US
Mailing Address - Phone:404-668-8461
Mailing Address - Fax:
Practice Address - Street 1:353 HERITAGE PARK TRCE NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-4832
Practice Address - Country:US
Practice Address - Phone:404-668-8461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN185513314000000X
FLRN9294975314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility