Marceline Nangah Awasom, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F01201684 Issued in GA

Practice address

2543 Zablan Ave
Bethlehem, GA 30620-7653

Phone

(912) 596-6407

NPI assigned

Mar 26, 2020

Last updated

Mar 26, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Restored Health Inc.

  • Family Medicine Physician
  • Lilburn, GA
  • NPI 1225242308
  Medicare reassignment NPD
• Divine Mercy Medical Group LLC

  • Family Medicine Physician
  • Lawrenceville, GA
  • NPI 1881419406
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585180800000",
    "number": "1619504800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2543 ZABLAN AVE",
            "city": "BETHLEHEM",
            "state": "GA",
            "postal_code": "306207653",
            "telephone_number": "912-596-6407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2543 ZABLAN AVE",
            "city": "BETHLEHEM",
            "state": "GA",
            "postal_code": "306207653",
            "telephone_number": "912-596-6407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AWASOM",
        "first_name": "MARCELINE",
        "middle_name": "NANGAH",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-26",
        "last_updated": "2020-03-26",
        "certification_date": "2020-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "F01201684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Bethlehem",
            "affiliation": "N",
            "address_1": "2543 Zablan Ave",
            "city": "Bethlehem",
            "state": "GA",
            "country_code": "US",
            "postal_code": "306207653",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Bethlehem",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "2543 Zablan Ave",
            "city": "Bethlehem",
            "state": "GA",
            "country_code": "US",
            "postal_code": "306207653",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Family Nurse Practitioner in Bethlehem, GA
• Providers in Bethlehem, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.