Healthcare Provider Details

I. General information

NPI: 1861356503
Provider Name (Legal Business Name): AKOSUA AGGREY-BEKOE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6952 DOGWOOD MNR N
OLIVE BRANCH MS
38654-2090
US

IV. Provider business mailing address

6952 DOGWOOD MNR N
OLIVE BRANCH MS
38654-2090
US

V. Phone/Fax

Practice location:
  • Phone: 901-571-8911
  • Fax:
Mailing address:
  • Phone: 901-571-8911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12111
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM10660
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: