Provider Demographics
NPI:1477230159
Name:KOUROUMA, FATOUMATA DIARIOU (FNP)
Entity type:Individual
Prefix:
First Name:FATOUMATA
Middle Name:DIARIOU
Last Name:KOUROUMA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 DUNAWAY CT
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-2201
Mailing Address - Country:US
Mailing Address - Phone:203-500-7823
Mailing Address - Fax:
Practice Address - Street 1:340 EXCHANGE BLVD STE 120
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:GA
Practice Address - Zip Code:30620-1759
Practice Address - Country:US
Practice Address - Phone:678-963-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN297468207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine