Individual
EBENEZER GYIMAH SARPONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8111 TIS WELL DR, ALEXANDRIA, VA 22306-3211
(703) 360-4000
Mailing address
2511 WINDBREAK DR, ALEXANDRIA, VA 22306-2605
(571) 420-7032
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
08/17/2015
Last updated
08/17/2015
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