Provider Demographics
NPI:1699041434
Name:FOMUKONG, MAH-FRI AKERE (MD)
Entity Type:Individual
Prefix:
First Name:MAH-FRI
Middle Name:AKERE
Last Name:FOMUKONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SCRANTON CONNECTOR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-0540
Mailing Address - Country:US
Mailing Address - Phone:912-262-2347
Mailing Address - Fax:912-262-3036
Practice Address - Street 1:107B FAHM STREET
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-2391
Practice Address - Country:US
Practice Address - Phone:912-262-2347
Practice Address - Fax:912-262-3036
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA074711207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine