Healthcare Provider Details

I. General information

NPI: 1558160598
Provider Name (Legal Business Name): FREDA FOSU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 NORTHSIDE FORSYTH DR
CUMMING GA
30041-7659
US

IV. Provider business mailing address

1535 STELTEN WAY
ALPHARETTA GA
30004-5328
US

V. Phone/Fax

Practice location:
  • Phone: 770-844-3218
  • Fax: 770-844-3227
Mailing address:
  • Phone: 770-521-6754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95194843
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number263516
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: