Healthcare Provider Details

I. General information

NPI: 1427821990
Provider Name (Legal Business Name): KOFI-ANN MCDERMOTT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 HILLANDALE DR
LITHONIA GA
30058-4103
US

IV. Provider business mailing address

1835 SAVOY DR STE 203
ATLANTA GA
30341-1073
US

V. Phone/Fax

Practice location:
  • Phone: 770-981-5431
  • Fax: 770-981-5515
Mailing address:
  • Phone: 770-496-9430
  • Fax: 404-891-4947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN272681
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: