Healthcare Provider Details

I. General information

NPI: 1912634593
Provider Name (Legal Business Name): ISAAC OFORI AMANFO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 HOSPITAL RD
NEWNAN GA
30263-1209
US

IV. Provider business mailing address

59 HOSPITAL RD
NEWNAN GA
30263-1209
US

V. Phone/Fax

Practice location:
  • Phone: 678-423-4610
  • Fax: 770-830-2266
Mailing address:
  • Phone: 678-423-4610
  • Fax: 770-830-2266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number307838
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number200607
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN265613
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61572854
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN265613
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: