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General NPI Number Information
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NPI Number | 1184916801
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Entity Type | Organization
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Legal Business Name | KWABENA AMPONSAH PA-C, PLLC
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Dates
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Enumeration Date | 05/12/2011
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 10524 MOSS PARK RD STE 204-771
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City | ORLANDO
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State | FL
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Zip | 32832-5898
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Country | US
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Telephone | 937-902-2068
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Fax |
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Provider Business Mailing Address
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Address Line | 10524 MOSS PARK RD STE 204-771
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City | ORLANDO
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State | FL
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Zip | 32832-5898
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Country | US
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Telephone | 937-902-2068
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. KWABENA AMPONSAH
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Credential | PA-C
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Telephone | 937-902-2068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME99974
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9104033
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License Number State | FL
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