Healthcare Provider Details

I. General information

NPI: 1851017420
Provider Name (Legal Business Name): NANA AMOAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 HANDLEY RD STE A
TYRONE GA
30290-2178
US

IV. Provider business mailing address

190 HANDLEY RD STE A
TYRONE GA
30290-2178
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-7980
  • Fax:
Mailing address:
  • Phone: 770-997-5714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN315584
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN315584
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: