Provider Demographics
NPI:1063096154
Name:KUETE, NELSON KEVIN TANEFO (MD)
Entity type:Individual
Prefix:
First Name:NELSON KEVIN
Middle Name:TANEFO
Last Name:KUETE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NELSON
Other - Middle Name:KEVIN TANEFO
Other - Last Name:KUETE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6911 SLATE STONE WAY SE
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-5425
Mailing Address - Country:US
Mailing Address - Phone:770-827-9756
Mailing Address - Fax:
Practice Address - Street 1:1365 CLIFTON RD NE STE B1400
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-778-4898
Practice Address - Fax:404-778-4006
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty