Provider Demographics
NPI:1871258251
Name:OPONG, NADINE (NP)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:OPONG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 DRUMMOND PT
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-6072
Mailing Address - Country:US
Mailing Address - Phone:347-836-2272
Mailing Address - Fax:
Practice Address - Street 1:1801 PEACH STREET NE
Practice Address - Street 2:SUITE 300
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1859
Practice Address - Country:US
Practice Address - Phone:404-800-5797
Practice Address - Fax:404-800-5181
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN282659363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily