Healthcare Provider Details

I. General information

NPI: 1679490171
Provider Name (Legal Business Name): BEN KWAME TSEYIBOR MLS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2026
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11935 ABERCORN ST
SAVANNAH GA
31419-1909
US

IV. Provider business mailing address

3050 COBB PKWY NW APT 3131
KENNESAW GA
30152-6563
US

V. Phone/Fax

Practice location:
  • Phone: 912-472-1928
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: