1083742803 NPI number — DR. FELICITY ARABA QUANSAH M.D.

Table of content: MRS. TERRESA MARIE GUENETTE CNA 2 (NPI 1366744674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083742803 NPI number — DR. FELICITY ARABA QUANSAH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUANSAH
Provider First Name:
FELICITY
Provider Middle Name:
ARABA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083742803
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1870 HARDEMAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31201-1161
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-743-2000
Provider Business Mailing Address Fax Number:
478-743-0096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1870 HARDEMAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31201-1161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-743-2000
Provider Business Practice Location Address Fax Number:
478-743-0096
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  028061 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003774426B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GRP6512 . This is a "MEDICARE GROUP PIN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 180038596 . This is a "RR MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: REF000035775 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1336277151 . This is a "GROUP NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 028061 . This is a "MEDICAL LICENSE NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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