Healthcare Provider Details

I. General information

NPI: 1376259838
Provider Name (Legal Business Name): MAAP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 POWERS FERRY RD SE STE 2128
MARIETTA GA
30067-1203
US

IV. Provider business mailing address

2000 POWERS FERRY RD SE STE 2128
MARIETTA GA
30067-1203
US

V. Phone/Fax

Practice location:
  • Phone: 678-768-8838
  • Fax:
Mailing address:
  • Phone: 678-768-8838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIAN POMAAH OPOKU-AGYEMAN
Title or Position: FNP-C
Credential:
Phone: 678-662-7741