Basic Information
| Provider Information | |||||||||
| NPI: | 1013922814 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ACQUAH | ||||||||
| FirstName: | EKOW | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ACQUAH | ||||||||
| OtherFirstName: | JOHN | ||||||||
| OtherMiddleName: | EKOW | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 15200 COMMUNITY RD | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | GULFPORT | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395033085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2285757243 | ||||||||
| FaxNumber: | 2285757420 | ||||||||
| Practice Location | |||||||||
| Address1: | 15200 COMMUNITY RD | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | GULFPORT | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395033085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2285757243 | ||||||||
| FaxNumber: | 2285757420 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 09/23/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| ParentOrganizationLBN: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 15951 | MS | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 0101242907 | VA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 00119697 | 05 | MS | MEDICAID | 1013922814 | 05 | VA | MEDICAID |