Healthcare Provider Details

I. General information

NPI: 1568206969
Provider Name (Legal Business Name): WINIFRED OPARE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 HURRICANE SHOALS RD NE STE 1800
LAWRENCEVILLE GA
30043-4849
US

IV. Provider business mailing address

5220 MIRROR LAKE DR
CUMMING GA
30028-7217
US

V. Phone/Fax

Practice location:
  • Phone: 470-740-0355
  • Fax:
Mailing address:
  • Phone: 470-354-9429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: