Provider Demographics
NPI:1780077461
Name:KOOMSON, GEORGINA THELMA (LPN)
Entity type:Individual
Prefix:
First Name:GEORGINA
Middle Name:THELMA
Last Name:KOOMSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:GEORGIA
Other - Middle Name:THELMA
Other - Last Name:NYARKOH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:7951 RICHMOND HWY
Mailing Address - Street 2:APT. # 31
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3019
Mailing Address - Country:US
Mailing Address - Phone:571-313-9339
Mailing Address - Fax:
Practice Address - Street 1:7951 RICHMOND HWY
Practice Address - Street 2:APT. # 31
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3019
Practice Address - Country:US
Practice Address - Phone:571-313-9339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAA60067095171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor