Provider Demographics
NPI:1275212615
Name:AFETOR-PRICE, PATIENCE AKUA
Entity Type:Individual
Prefix:
First Name:PATIENCE
Middle Name:AKUA
Last Name:AFETOR-PRICE
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 1:401 PIKE BLVD STE G2
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3350
Mailing Address - Country:US
Mailing Address - Phone:678-979-7739
Mailing Address - Fax:
Practice Address - Street 1:401 PIKE BLVD STE G2
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3350
Practice Address - Country:US
Practice Address - Phone:678-979-7739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF06231880363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily