Provider Demographics
NPI:1750831954
Name:AMOUGOU AMOUGOU, YVES-AIME (PMHNP-BC, FNP-C)
Entity Type:Individual
Prefix:MR
First Name:YVES-AIME
Middle Name:
Last Name:AMOUGOU AMOUGOU
Suffix:
Gender:M
Credentials:PMHNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 DUBLIN WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132
Mailing Address - Country:US
Mailing Address - Phone:678-523-7607
Mailing Address - Fax:
Practice Address - Street 1:KAISER PERMANENTE BEHAVIORAL HEALTH
Practice Address - Street 2:1100 LAKE HEARN DRIVE
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-365-0966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA212975363L00000X
GAAPRN-212975363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003194359AMedicaid