Provider Demographics
NPI:1912596222
Name:FENIN, KWAKU
Entity Type:Individual
Prefix:DR
First Name:KWAKU
Middle Name:
Last Name:FENIN
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 1:3940 JONESBORO RD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-2258
Mailing Address - Country:US
Mailing Address - Phone:770-774-1161
Mailing Address - Fax:779-774-4461
Practice Address - Street 1:3940 JONESBORO RD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-2258
Practice Address - Country:US
Practice Address - Phone:770-774-1161
Practice Address - Fax:779-774-4461
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist