Healthcare Provider Details

I. General information

NPI: 1215376140
Provider Name (Legal Business Name): ANOTA AKOFU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 DIXIE ST
CARROLLTON GA
30117-4408
US

IV. Provider business mailing address

905 DIXIE ST
CARROLLTON GA
30117-4408
US

V. Phone/Fax

Practice location:
  • Phone: 678-796-0681
  • Fax: 770-836-8477
Mailing address:
  • Phone: 678-796-0681
  • Fax: 770-836-8477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number98666
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125063850
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: