Basic Information
| Provider Information | |||||||||
| NPI: | 1609301340 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANTWI - BADU | ||||||||
| FirstName: | PHILIP | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1960 LILY STEM TRL | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300112150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708550394 | ||||||||
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| Practice Location | |||||||||
| Address1: | 49169 ROAD 426 | ||||||||
| Address2: | |||||||||
| City: | OAKHURST | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936448702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596644000 | ||||||||
| FaxNumber: | 5596755224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2017 | ||||||||
| LastUpdateDate: | 01/07/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 95007443 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.