Provider Demographics
NPI:1245276765
Name:KOFI NUAKO, MD, PC
Entity type:Organization
Organization Name:KOFI NUAKO, MD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HAYLEY
Authorized Official - Middle Name:MAREE
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:CPPM
Authorized Official - Phone:731-884-0600
Mailing Address - Street 1:1109 E REELFOOT AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-5856
Mailing Address - Country:US
Mailing Address - Phone:731-884-0600
Mailing Address - Fax:731-885-6171
Practice Address - Street 1:1109 E REELFOOT AVE
Practice Address - Street 2:SUITE C
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5856
Practice Address - Country:US
Practice Address - Phone:731-884-0600
Practice Address - Fax:731-885-6171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD31272207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3723214Medicaid
TN3836905Medicare ID - Type UnspecifiedNUAKO MEDICARE
TN3640074Medicare ID - Type UnspecifiedLAURA RUSSELL MEDICARE
TN3723214Medicare ID - Type UnspecifiedCLINIC GROUP