Provider Demographics
NPI:1487880761
Name:AGYEMANG, WILLIAM OPOKU BADU (ANP-BC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:OPOKU BADU
Last Name:AGYEMANG
Suffix:
Gender:M
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 GULF STREAM ROAD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:GA
Mailing Address - Zip Code:31408
Mailing Address - Country:US
Mailing Address - Phone:912-965-6329
Mailing Address - Fax:
Practice Address - Street 1:851 SOUTHBRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-1096
Practice Address - Country:US
Practice Address - Phone:912-663-6502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN154407 NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health