Provider Demographics
NPI:1558600718
Name:ACHEAMPONG, NICHOLAS SARKODIE (IDC)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:SARKODIE
Last Name:ACHEAMPONG
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3502 ATTU RD
Mailing Address - Street 2:.BLDG 806
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92155-5506
Mailing Address - Country:US
Mailing Address - Phone:619-522-7650
Mailing Address - Fax:
Practice Address - Street 1:3502 ATTU RD
Practice Address - Street 2:.BLDG 806
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92155-5506
Practice Address - Country:US
Practice Address - Phone:619-522-7650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman