Provider Demographics
NPI:1275341018
Name:SAMJELLA, PRIDE AKAMDAWOH
Entity type:Individual
Prefix:
First Name:PRIDE AKAMDAWOH
Middle Name:
Last Name:SAMJELLA
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 1:5910 UPPER CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-5407
Mailing Address - Country:US
Mailing Address - Phone:301-531-0091
Mailing Address - Fax:
Practice Address - Street 1:5910 UPPER CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-5407
Practice Address - Country:US
Practice Address - Phone:301-531-0091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator