Provider Demographics
NPI:1194072058
Name:DEGOH, ROSEMARY JINGWA (FNP)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:JINGWA
Last Name:DEGOH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2782 N COBB PKWY
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-3472
Mailing Address - Country:US
Mailing Address - Phone:240-351-4505
Mailing Address - Fax:401-652-9787
Practice Address - Street 1:2782 N COBB PKWY
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-3472
Practice Address - Country:US
Practice Address - Phone:240-351-4505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN241507363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily