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NPI Code Detail

MEDICARE: DR. AFUA SARPON BOATEN MD

MEDICARE: DR. AFUA SARPON BOATEN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician47166TN
2207Q00000XFamily Medicine Physician54207GA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1202I080456OTHERGAMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972597656
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AFUA SARPON BOATEN MD
Provider Business Mailing Address
First Line : 1046 RIDGE AVE SW
Second Line : SOUTHSIDE MEDICAL CENTER
City : ATLANTA
State : GA
Zip : 30315-1640
Country : US
Telephone Number : 404-688-1350
Fax Number : 404-801-3959
Provider Business Practice Location Address
First Line : 1046 RIDGE AVE SW
Second Line : SOUTHSIDE MEDICAL CENTER
City : ATLANTA
State : GA
Zip : 30315-1640
Country : US
Telephone Number : 404-688-1350
Fax Number : 404-801-3959
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2005
Last Update Date : 02/19/2015

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Directions to “ DR. AFUA SARPON BOATEN MD” Practice Location

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