Provider Demographics
NPI:1285975839
Name:GOVI-AMOUSSOUVI, AGBEGNIGAN OLYMPE
Entity type:Individual
Prefix:MR
First Name:AGBEGNIGAN
Middle Name:OLYMPE
Last Name:GOVI-AMOUSSOUVI
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 1:4102 TWIN CIRCLE WAY
Mailing Address - Street 2:
Mailing Address - City:HALETHORPE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-3514
Mailing Address - Country:US
Mailing Address - Phone:240-501-6838
Mailing Address - Fax:
Practice Address - Street 1:7412 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1754
Practice Address - Country:US
Practice Address - Phone:202-291-6973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide