Provider Demographics
NPI:1508696618
Name:OPOKU PEPRAH, BERTHA (FNP)
Entity type:Individual
Prefix:
First Name:BERTHA
Middle Name:
Last Name:OPOKU PEPRAH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-8027
Mailing Address - Country:US
Mailing Address - Phone:470-390-2113
Mailing Address - Fax:
Practice Address - Street 1:912 ARBOR DR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-8027
Practice Address - Country:US
Practice Address - Phone:470-390-2113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA221643363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily