Healthcare Provider Details

I. General information

NPI: 1740107416
Provider Name (Legal Business Name): ROMEO YEBOAH BOAHENG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST # BA3415
AUGUSTA GA
30912-0006
US

IV. Provider business mailing address

1399 WALTON WAY APT 204
AUGUSTA GA
30901-2683
US

V. Phone/Fax

Practice location:
  • Phone: 762-375-2822
  • Fax:
Mailing address:
  • Phone: 706-351-8383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number113870
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: