Healthcare Provider Details

I. General information

NPI: 1598212847
Provider Name (Legal Business Name): AFUA BOATEMAA ACHEAMPONG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AFUA BOATEMAA PA-C

II. Dates (important events)

Enumeration Date: 09/03/2016
Last Update Date: 08/19/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6909 PROSPERITY CHURCH RD
HUNTERSVILLE NC
28078-6698
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-316-2050
  • Fax: 704-316-2051
Mailing address:
  • Phone: 704-316-2050
  • Fax: 704-316-2051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001006467
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: