Provider Demographics
NPI:1366793945
Name:MENSAH, MAVIS K (RN)
Entity type:Individual
Prefix:
First Name:MAVIS
Middle Name:K
Last Name:MENSAH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 CABARET CT SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3618
Mailing Address - Country:US
Mailing Address - Phone:770-912-2436
Mailing Address - Fax:
Practice Address - Street 1:3807 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-4911
Practice Address - Country:US
Practice Address - Phone:770-454-1144
Practice Address - Fax:770-452-4470
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN110178163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse