Healthcare Provider Details

I. General information

NPI: 1780911776
Provider Name (Legal Business Name): GIFTY O TWUMASI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 DALLAS HWY
POWDER SPRINGS GA
30127-4263
US

IV. Provider business mailing address

4165 30TH AVE S STE 101
FARGO ND
58104-8419
US

V. Phone/Fax

Practice location:
  • Phone: 866-825-3227
  • Fax: 866-397-7399
Mailing address:
  • Phone: 866-825-3227
  • Fax: 866-397-7399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN186816
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: