Provider Demographics
NPI:1346748902
Name:BAH, FATOUMATA YEBHE
Entity Type:Individual
Prefix:
First Name:FATOUMATA
Middle Name:YEBHE
Last Name:BAH
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 1:10309 MADISON DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346-2476
Mailing Address - Country:US
Mailing Address - Phone:978-221-0550
Mailing Address - Fax:
Practice Address - Street 1:10309 MADISON DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30346-2476
Practice Address - Country:US
Practice Address - Phone:978-221-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker