MEDICARE: DIONNE ASANTEWAA AGYEMANG PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	6193	SC
2	363A00000X	Physician Assistant	0010-14277	NC

General Provider Information

NPI Number	:	1033860788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIONNE ASANTEWAA AGYEMANG PA

Provider Business Mailing Address
First Line	:	7613 WOODKNOLL DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-7982
Country	:	US
Telephone Number	:	704-957-8255
Fax Number	:

Provider Business Practice Location Address
First Line	:	2540 W ARROWOOD RD STE 110
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28273-6198
Country	:	US
Telephone Number	:	704-588-9997
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2022
Last Update Date	:	04/21/2026

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