Healthcare Provider Details

I. General information

NPI: 1750167474
Provider Name (Legal Business Name): ANTHIA KARGBO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5977 ENDICOTT RD
COLUMBUS OH
43229-2631
US

IV. Provider business mailing address

5977 ENDICOTT RD
COLUMBUS OH
43229-2631
US

V. Phone/Fax

Practice location:
  • Phone: 380-232-1845
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: