Provider Demographics
NPI:1295226199
Name:AFATSAWO, ABLA DJIGBODI (APRN)
Entity Type:Individual
Prefix:DR
First Name:ABLA
Middle Name:DJIGBODI
Last Name:AFATSAWO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 N BENBOW RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27411-9084
Mailing Address - Country:US
Mailing Address - Phone:336-334-7880
Mailing Address - Fax:
Practice Address - Street 1:112 N BENBOW RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27411-0001
Practice Address - Country:US
Practice Address - Phone:336-334-7880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010554363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner