Provider Demographics
NPI:1184373656
Name:HATCH, AKOSUA
Entity type:Individual
Prefix:
First Name:AKOSUA
Middle Name:
Last Name:HATCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 HARRISON BOULEVARD
Mailing Address - Street 2:STE A700
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403
Mailing Address - Country:US
Mailing Address - Phone:801-387-5300
Mailing Address - Fax:801-442-0648
Practice Address - Street 1:4403 HARRISON BOULEVARD
Practice Address - Street 2:STE A700
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403
Practice Address - Country:US
Practice Address - Phone:801-387-5300
Practice Address - Fax:801-442-0648
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
UT13760325-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program