Provider Demographics
NPI:1558927707
Name:ESSUMAN-NELSON, AUGUSTA (DO)
Entity Type:Individual
Prefix:
First Name:AUGUSTA
Middle Name:
Last Name:ESSUMAN-NELSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 CEDARWOOD DR APT A1
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1848
Mailing Address - Country:US
Mailing Address - Phone:937-269-6172
Mailing Address - Fax:
Practice Address - Street 1:232 19TH ST NW STE 7220
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30363-1131
Practice Address - Country:US
Practice Address - Phone:404-367-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.031135207R00000X
GA92366207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine