Provider Demographics
NPI:1861817181
Name:DORWUONA-TETTEY, JOANA
Entity Type:Individual
Prefix:
First Name:JOANA
Middle Name:
Last Name:DORWUONA-TETTEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOANA
Other - Middle Name:
Other - Last Name:LARYEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:204 N WESTOVER BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-2983
Mailing Address - Country:US
Mailing Address - Phone:229-888-6559
Mailing Address - Fax:229-436-4107
Practice Address - Street 1:204 N WESTOVER BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-2983
Practice Address - Country:US
Practice Address - Phone:229-888-6559
Practice Address - Fax:229-436-4107
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA076705208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics