Healthcare Provider Details

I. General information

NPI: 1780077461
Provider Name (Legal Business Name): GEORGINA THELMA KOOMSON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GEORGIA THELMA NYARKOH LPN

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7951 RICHMOND HWY APT. # 31
ALEXANDRIA VA
22306-3019
US

IV. Provider business mailing address

7951 RICHMOND HWY APT. # 31
ALEXANDRIA VA
22306-3019
US

V. Phone/Fax

Practice location:
  • Phone: 571-313-9339
  • Fax:
Mailing address:
  • Phone: 571-313-9339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberA60067095
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: