Provider Demographics
NPI:1821214909
Name:AGYEPONG, DOROTHY DEE (CPNP)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:DEE
Last Name:AGYEPONG
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2650
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-2650
Mailing Address - Country:US
Mailing Address - Phone:229-353-3422
Mailing Address - Fax:
Practice Address - Street 1:39 KENT RD STE 5
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-1697
Practice Address - Country:US
Practice Address - Phone:229-353-7337
Practice Address - Fax:229-391-4051
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN109364363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000928826FMedicaid
GA000928826DMedicaid
GA000928826EMedicaid
GA000928826CMedicaid