Healthcare Provider Details

I. General information

NPI: 1003411059
Provider Name (Legal Business Name): JOSEPH GYABAAH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 10/25/2024
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 E KENNEDY ST
SPARTANBURG SC
29302-1912
US

IV. Provider business mailing address

8000 YORK RD
TOWSON MD
21252-0001
US

V. Phone/Fax

Practice location:
  • Phone: 864-583-0053
  • Fax: 864-583-0390
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA63121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: