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General NPI Number Information
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NPI Number | 1992314439
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Entity Type | Individual
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Provider Name | PHILIP BOADU NP
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Gender | Male
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Dates
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Enumeration Date | 07/30/2020
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 4763 ATLANTA HWY STE 420
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City | LOGANVILLE
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State | GA
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Zip | 30052-6788
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Country | US
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Telephone | 404-395-6781
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Fax |
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Provider Business Mailing Address
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Address Line | 452 SPRINGLAKE RD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-5090
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Country | US
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Telephone | 646-226-7209
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN-NP303104
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 651299
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | F346860-01
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License Number State | NY
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