Provider Demographics
NPI:1407527864
Name:MUTEMWA, ASSUMPTA MWETHYA (CNA)
Entity Type:Individual
Prefix:
First Name:ASSUMPTA
Middle Name:MWETHYA
Last Name:MUTEMWA
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2227 EAGLES NEST CIR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-2227
Mailing Address - Country:US
Mailing Address - Phone:678-913-9282
Mailing Address - Fax:
Practice Address - Street 1:2227 EAGLES NEST CIR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-2227
Practice Address - Country:US
Practice Address - Phone:678-913-9282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0028885586376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide