Provider Demographics
NPI:1417969338
Name:KUMI, KOFI OWUSU (MD)
Entity Type:Individual
Prefix:DR
First Name:KOFI
Middle Name:OWUSU
Last Name:KUMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SGT PRENTISS DR
Mailing Address - Street 2:100
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4782
Mailing Address - Country:US
Mailing Address - Phone:601-304-0020
Mailing Address - Fax:601-304-0023
Practice Address - Street 1:55 SGT PRENTISS DR
Practice Address - Street 2:100
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4782
Practice Address - Country:US
Practice Address - Phone:601-304-0020
Practice Address - Fax:601-304-0023
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15330174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS640892171OtherFEDERAL TAX ID
MS00118246Medicaid
MS00118246Medicaid
MSG 41132Medicare UPIN