Provider Demographics
NPI:1972597656
Name:BOATEN, AFUA SARPON (MD)
Entity Type:Individual
Prefix:DR
First Name:AFUA
Middle Name:SARPON
Last Name:BOATEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1046 RIDGE AVE SW
Mailing Address - Street 2:SOUTHSIDE MEDICAL CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-1640
Mailing Address - Country:US
Mailing Address - Phone:404-688-1350
Mailing Address - Fax:404-801-3959
Practice Address - Street 1:1046 RIDGE AVE SW
Practice Address - Street 2:SOUTHSIDE MEDICAL CENTER
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-1640
Practice Address - Country:US
Practice Address - Phone:404-688-1350
Practice Address - Fax:404-801-3959
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN47166207Q00000X
GA54207207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I080456OtherMEDICARE PTAN
GA403610618A,BMedicaid
GA403610618Medicaid
GA403610618Medicaid
GA403610618A,BMedicaid