MEDICARE: VIVIAN ADU-ABOAGYE

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	163W00000X	Registered Nurse	RN224834	GA
2	363LF0000X	Family Nurse Practitioner	RN224834	GA

General Provider Information

NPI Number	:	1043798838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN ADU-ABOAGYE

Provider Business Mailing Address
First Line	:	7603 FOREST GLEN WAY
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-6868
Country	:	US
Telephone Number	:	470-331-9468
Fax Number	:

Provider Business Practice Location Address
First Line	:	7603 FOREST GLEN WAY
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122
Country	:	US
Telephone Number	:	470-331-9468
Fax Number	:

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

Provider Enumeration Date	:	08/02/2018
Last Update Date	:	06/10/2021

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Directions to “ VIVIAN ADU-ABOAGYE ” Practice Location

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