Provider Demographics
NPI:1457463143
Name:OPPONG, JAMES YAW JR
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:YAW
Last Name:OPPONG
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3951 PLEASANTDALE RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340-4256
Mailing Address - Country:US
Mailing Address - Phone:770-729-1086
Mailing Address - Fax:
Practice Address - Street 1:3951 PLEASANTDALE RD
Practice Address - Street 2:SUITE 114
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-4256
Practice Address - Country:US
Practice Address - Phone:770-729-1086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00203367332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5219890003Medicare ID - Type UnspecifiedPROVIDER IDENTIFICATION