Healthcare Provider Details

I. General information

NPI: 1780212811
Provider Name (Legal Business Name): KWAKU YEBOAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 WESTVIEW DR SW
ATLANTA GA
30310-1458
US

IV. Provider business mailing address

720 WESTVIEW DR SW
ATLANTA GA
30310-1458
US

V. Phone/Fax

Practice location:
  • Phone: 404-756-1451
  • Fax: 404-756-1471
Mailing address:
  • Phone: 404-756-1451
  • Fax: 404-756-1471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number95576
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: