Provider Demographics
NPI:1629717590
Name:ADDO, GYAN KWABENA
Entity Type:Individual
Prefix:MR
First Name:GYAN
Middle Name:KWABENA
Last Name:ADDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4697 STONECASTLE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-6532
Mailing Address - Country:US
Mailing Address - Phone:413-841-5516
Mailing Address - Fax:
Practice Address - Street 1:4697 STONECASTLE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-6532
Practice Address - Country:US
Practice Address - Phone:413-841-5516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHUE067511172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver