Healthcare Provider Details

I. General information

NPI: 1811574957
Provider Name (Legal Business Name): KWAME OWURA FRIMPONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 05/29/2023
Certification Date: 05/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 BUFORD HWY NE STE 195
BROOKHAVEN GA
30329-2124
US

IV. Provider business mailing address

PO BOX 232
WINDER GA
30680-0232
US

V. Phone/Fax

Practice location:
  • Phone: 770-284-1044
  • Fax: 770-284-1044
Mailing address:
  • Phone: 404-514-4146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC007536
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: