Provider Demographics
NPI:1750897914
Name:ABLAKWA, GODWIN
Entity type:Individual
Prefix:
First Name:GODWIN
Middle Name:
Last Name:ABLAKWA
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 1:3550 CHERRY HILL CT
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3657
Mailing Address - Country:US
Mailing Address - Phone:240-360-6143
Mailing Address - Fax:
Practice Address - Street 1:3550 CHERRY HILL CT
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3657
Practice Address - Country:US
Practice Address - Phone:240-360-6143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-22
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA142285078967OtherDRIVERS LICENSE