Provider Demographics
NPI:1235910019
Name:OFOSU, GIDEON
Entity Type:Individual
Prefix:
First Name:GIDEON
Middle Name:
Last Name:OFOSU
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 1:285 SHORELINE DR
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:NC
Mailing Address - Zip Code:28127-9308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:285 SHORELINE DR
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:NC
Practice Address - Zip Code:28127-9308
Practice Address - Country:US
Practice Address - Phone:470-430-5076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN292721163WC0200X
GARN292179163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine