Provider Demographics
NPI:1427821990
Name:MCDERMOTT, KOFI-ANN (NP)
Entity type:Individual
Prefix:
First Name:KOFI-ANN
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 SAVOY DR STE 203
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1073
Mailing Address - Country:US
Mailing Address - Phone:770-496-9430
Mailing Address - Fax:404-891-4947
Practice Address - Street 1:5700 HILLANDALE DR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-4103
Practice Address - Country:US
Practice Address - Phone:770-981-5431
Practice Address - Fax:770-981-5515
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN272681363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner