Provider Demographics
NPI:1063623304
Name:YIADOM, AKWASI BOACHIE
Entity type:Individual
Prefix:MR
First Name:AKWASI
Middle Name:BOACHIE
Last Name:YIADOM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1197 S HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-1344
Mailing Address - Country:US
Mailing Address - Phone:614-237-3840
Mailing Address - Fax:
Practice Address - Street 1:1197 S HAMILTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-1344
Practice Address - Country:US
Practice Address - Phone:614-237-3840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2663194320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities