Provider Demographics
NPI:1083732978
Name:OPARAH, THERESA O (FNP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:O
Last Name:OPARAH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WINTERBERRY RDG
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-3476
Mailing Address - Country:US
Mailing Address - Phone:404-384-3996
Mailing Address - Fax:
Practice Address - Street 1:9721 ORMSBY STATION RD
Practice Address - Street 2:STE 106
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4095
Practice Address - Country:US
Practice Address - Phone:502-423-1103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN084496363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN084496OtherLICENSE