Provider Demographics
NPI:1053673079
Name:JUPSIA, TITA
Entity Type:Individual
Prefix:
First Name:TITA
Middle Name:
Last Name:JUPSIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4303 N SHALLOWFORD RD APT 2104
Mailing Address - Street 2:LL18A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1140
Mailing Address - Country:US
Mailing Address - Phone:678-349-6060
Mailing Address - Fax:
Practice Address - Street 1:7826 EASTERN AVE NW
Practice Address - Street 2:LL18A
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1324
Practice Address - Country:US
Practice Address - Phone:678-349-6060
Practice Address - Fax:678-349-6060
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide