Healthcare Provider Details

I. General information

NPI: 1538787437
Provider Name (Legal Business Name): LOUISA MENSAH OWUSU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 DOUBLE CREEK DR
POWDER SPRINGS GA
30127-7009
US

IV. Provider business mailing address

2045 DOUBLE CREEK DR
POWDER SPRINGS GA
30127-7009
US

V. Phone/Fax

Practice location:
  • Phone: 770-853-9558
  • Fax: 678-388-0843
Mailing address:
  • Phone: 770-853-9558
  • Fax: 678-388-0843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN187916
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: