Provider Demographics
NPI:1770348005
Name:AKYEA - MENSAH, PHILOMINA
Entity type:Individual
Prefix:MRS
First Name:PHILOMINA
Middle Name:
Last Name:AKYEA - MENSAH
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 1:2289 ARLINGTON WALK LN
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-7890
Mailing Address - Country:US
Mailing Address - Phone:770-906-7656
Mailing Address - Fax:
Practice Address - Street 1:709 BREEDLOVE DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2055
Practice Address - Country:US
Practice Address - Phone:770-906-7656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA243284163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty