Healthcare Provider Details

I. General information

NPI: 1174152870
Provider Name (Legal Business Name): PRINCE NKANSAH DWAMENA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2020
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 PRINCE AVE STE 201
ATHENS GA
30606-2789
US

IV. Provider business mailing address

1199 PRINCE AVE # 70
ATHENS GA
30606-2797
US

V. Phone/Fax

Practice location:
  • Phone: 706-475-7055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD480858
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD480858
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: