Healthcare Provider Details

I. General information

NPI: 1740210426
Provider Name (Legal Business Name): KOFI ADELEKE DOONQUAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2509 RICHARDSON DR STE A
REIDSVILLE NC
27320
US

IV. Provider business mailing address

2509 RICHARDSON DR STE A
REIDSVILLE NC
27320-5926
US

V. Phone/Fax

Practice location:
  • Phone: 336-347-7998
  • Fax:
Mailing address:
  • Phone: 336-347-7998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number200000774
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number200000774
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: