Healthcare Provider Details

I. General information

NPI: 1457002735
Provider Name (Legal Business Name): KWASI ARTHUR BAIDOO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 HARVEST WALK
MACON GA
31210-5514
US

IV. Provider business mailing address

326 HARVEST WALK
MACON GA
31210-5514
US

V. Phone/Fax

Practice location:
  • Phone: 478-508-1333
  • Fax:
Mailing address:
  • Phone: 478-508-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: