Provider Demographics
NPI:1972385284
Name:ASAMOAH, COLLINS KOFI
Entity Type:Individual
Prefix:
First Name:COLLINS
Middle Name:KOFI
Last Name:ASAMOAH
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 1:1945 POWERS FERRY RD SE APT 424
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5887
Mailing Address - Country:US
Mailing Address - Phone:267-471-5526
Mailing Address - Fax:
Practice Address - Street 1:3905 DUE WEST RD NW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-1019
Practice Address - Country:US
Practice Address - Phone:678-290-5740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH034577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist