Provider Demographics
NPI:1912151895
Name:ADUSEI, ANDY BAFI (MD)
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:BAFI
Last Name:ADUSEI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 BALL CAMP PIKE STE A
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921-3312
Mailing Address - Country:US
Mailing Address - Phone:865-544-1550
Mailing Address - Fax:658-544-1570
Practice Address - Street 1:4320 BALL CAMP PIKE STE A
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-3312
Practice Address - Country:US
Practice Address - Phone:865-544-1550
Practice Address - Fax:658-544-1570
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26627208600000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN56477OtherMEDICAL LICENSE