Provider Demographics
NPI:1780280503
Name:DONKOR, KENNEDY LEWIS
Entity type:Individual
Prefix:
First Name:KENNEDY
Middle Name:LEWIS
Last Name:DONKOR
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 1:5304 BUFORD HWY
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-2606
Mailing Address - Country:US
Mailing Address - Phone:770-209-0296
Mailing Address - Fax:770-209-0296
Practice Address - Street 1:4955 SUGARLOAF PKWY STE 124
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-8838
Practice Address - Country:US
Practice Address - Phone:678-577-9651
Practice Address - Fax:678-223-3302
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH018591183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist