Provider Demographics
NPI:1891134953
Name:KOMLA, KWAMI
Entity Type:Individual
Prefix:
First Name:KWAMI
Middle Name:
Last Name:KOMLA
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 1:3163 QUEENS CHAPEL RD #102
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712
Mailing Address - Country:US
Mailing Address - Phone:240-505-7358
Mailing Address - Fax:
Practice Address - Street 1:3163 QUEENS CHAPEL RD #102
Practice Address - Street 2:
Practice Address - City:MOUNT RAINIER
Practice Address - State:MD
Practice Address - Zip Code:20712
Practice Address - Country:US
Practice Address - Phone:240-505-7358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide