MEDICARE: BENJAMIN AKOSA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	055563	GA

General Provider Information

NPI Number	:	1255427225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN AKOSA M.D.

Provider Business Mailing Address
First Line	:	1325 SATELLITE BLVD NW BLDG 400
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-4651
Country	:	US
Telephone Number	:	678-263-3080
Fax Number	:	678-496-9863

Provider Business Practice Location Address
First Line	:	1325 SATELLITE BLVD NW BLDG 400
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-4651
Country	:	US
Telephone Number	:	678-263-3080
Fax Number	:	678-496-9863

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/12/2021

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