Provider Demographics
NPI:1255052791
Name:OPPONG, QUINTEN PEPRAH
Entity type:Individual
Prefix:
First Name:QUINTEN
Middle Name:PEPRAH
Last Name:OPPONG
Suffix:
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 1:444 FOREST HILL RD APT 512
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4808
Mailing Address - Country:US
Mailing Address - Phone:770-744-7566
Mailing Address - Fax:
Practice Address - Street 1:4292 GRAY HWY
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:GA
Practice Address - Zip Code:31032-5900
Practice Address - Country:US
Practice Address - Phone:478-986-2500
Practice Address - Fax:478-864-1288
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist