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General NPI Number Information
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NPI Number | 1912775263
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Entity Type | Individual
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Provider Name | KOSSIWA YAWLI
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Gender | Female
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Dates
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Enumeration Date | 12/15/2023
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 118 NORTH AVE STE F
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City | JONESBORO
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State | GA
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Zip | 30236-8408
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Country | US
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Telephone | 404-509-6192
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Fax |
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Provider Business Mailing Address
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Address Line | 118 NORTH AVE STE F
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City | JONESBORO
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State | GA
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Zip | 30236-8408
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Country | US
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Telephone | 404-509-6192
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WI0500X
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Taxonomy Name | Infusion Therapy Registered Nurse
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License Number | 268783
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163WI0500X
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Taxonomy Name | Infusion Therapy Registered Nurse
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License Number | RN268783
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License Number State | GA
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