Provider Demographics
NPI:1982812475
Name:OPOKU, STEPHEN KWAKU (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:KWAKU
Last Name:OPOKU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 WEMBLEY CIR
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-6756
Mailing Address - Country:US
Mailing Address - Phone:770-352-9067
Mailing Address - Fax:
Practice Address - Street 1:4600 FULTON MILL RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31208-2501
Practice Address - Country:US
Practice Address - Phone:478-471-2943
Practice Address - Fax:478-471-2912
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0496002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry