Healthcare Provider Details

I. General information

NPI: 1609347798
Provider Name (Legal Business Name): JAMES AWUAH PA-C, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 MAJOR ALLEN ST
MARTIN SD
57551-6005
US

IV. Provider business mailing address

102 MAJOR ALLEN ST
MARTIN SD
57551-6005
US

V. Phone/Fax

Practice location:
  • Phone: 605-685-1660
  • Fax: 605-685-1665
Mailing address:
  • Phone: 605-685-1660
  • Fax: 605-685-1665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: