Healthcare Provider Details

I. General information

NPI: 1790929859
Provider Name (Legal Business Name): EDWARD KOJO-EYIAH KOOMSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W 3RD AVE STE 700
ALBANY GA
31701-1969
US

IV. Provider business mailing address

1000 N LEE AVE ROOM 4404
OKLAHOMA CITY OK
73102-1036
US

V. Phone/Fax

Practice location:
  • Phone: 229-312-7790
  • Fax: 229-312-7795
Mailing address:
  • Phone: 405-272-6406
  • Fax: 405-272-6075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number076035
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number28989
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: