Provider Demographics
NPI:1063803260
Name:YEBOAH, MAVIS NYARKO (WHNP)
Entity type:Individual
Prefix:
First Name:MAVIS
Middle Name:NYARKO
Last Name:YEBOAH
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:699 CHURCH ST NE STE 320
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1122
Mailing Address - Country:US
Mailing Address - Phone:770-819-9211
Mailing Address - Fax:770-819-9616
Practice Address - Street 1:699 CHURCH ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1110
Practice Address - Country:US
Practice Address - Phone:770-819-9211
Practice Address - Fax:770-819-9161
Is Sole Proprietor?:No
Enumeration Date:2015-02-10
Last Update Date:2022-07-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN181677363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health