Provider Demographics
NPI:1902540578
Name:KAMATE, NAWA EMMANUELLA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:NAWA
Middle Name:EMMANUELLA
Last Name:KAMATE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 LISMORE SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-8518
Mailing Address - Country:US
Mailing Address - Phone:720-314-8734
Mailing Address - Fax:
Practice Address - Street 1:2431 SANDTOWN RD SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-6660
Practice Address - Country:US
Practice Address - Phone:720-314-8734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2023-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF03220375363LF0000X
GARN259271363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty