Healthcare Provider Details

I. General information

NPI: 1669859518
Provider Name (Legal Business Name): ALHASSANE KOUYATE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6820 ROSWELL RD STE 2B
ATLANTA GA
30328-2404
US

IV. Provider business mailing address

6820 ROSWELL RD STE 2B
ATLANTA GA
30328-2404
US

V. Phone/Fax

Practice location:
  • Phone: 404-519-4514
  • Fax:
Mailing address:
  • Phone: 404-519-4514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number060-R-1364
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number060-R-1364
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number060-R-1364
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: