Provider Demographics
NPI:1376137844
Name:DR. OWUSU PROFESSIONAL SERVICES, INC
Entity Type:Organization
Organization Name:DR. OWUSU PROFESSIONAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:OWUSU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-507-9407
Mailing Address - Street 1:5035 HAWKS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-2043
Mailing Address - Country:US
Mailing Address - Phone:706-507-9407
Mailing Address - Fax:706-507-9408
Practice Address - Street 1:2022 10TH AVE STE B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3720
Practice Address - Country:US
Practice Address - Phone:855-575-4622
Practice Address - Fax:706-507-9408
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. OWUSU PROFESSIONAL SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty