Provider Demographics
NPI:1225585565
Name:KYEI-FRIMPONG, JUSTIN KWASI
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:KWASI
Last Name:KYEI-FRIMPONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 MERCER UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-4117
Mailing Address - Country:US
Mailing Address - Phone:478-471-6669
Mailing Address - Fax:478-471-9164
Practice Address - Street 1:4305 MERCER UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-4117
Practice Address - Country:US
Practice Address - Phone:478-471-6669
Practice Address - Fax:478-471-9164
Is Sole Proprietor?:No
Enumeration Date:2016-09-02
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029105183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist