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NPI Code Detail

MEDICARE: DR. MAXINE OWUSU M.D

MEDICARE: DR. MAXINE OWUSU M.D
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
1207Q00000XFamily Medicine Physician78170GA
2261QU0200XUrgent Care Clinic/Center78170GA
3207P00000XEmergency Medicine Physician78170GA

General Provider Information

NPI Number : 1972923258
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MAXINE OWUSU M.D
Provider Business Mailing Address
First Line : 911 LAKESIDE VILLA DR # 911
Second Line :
City : HAMPTON
State : GA
Zip : 30228-6351
Country : US
Telephone Number : 315-395-7874
Fax Number :
Provider Business Practice Location Address
First Line : 601 S 8TH ST
Second Line :
City : GRIFFIN
State : GA
Zip : 30224-4213
Country : US
Telephone Number : 770-228-2721
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2014
Last Update Date : 02/04/2026

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