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NPI Code Detail

MEDICARE: DR. FANTA KONATE PHARMD

MEDICARE: DR. FANTA KONATE PHARMD
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
1183500000XPharmacist025169GA

General Provider Information

NPI Number : 1457678369
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FANTA KONATE PHARMD
Provider Business Mailing Address
First Line : 4232 MERLE CT
Second Line :
City : MCDONOUGH
State : GA
Zip : 30252-8124
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2175 PARKLAKE DR NE
Second Line :
City : ATLANTA
State : GA
Zip : 30345-2845
Country : US
Telephone Number : 770-496-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2010
Last Update Date : 11/26/2020

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Directions to “ DR. FANTA KONATE PHARMD” Practice Location

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