Provider Demographics
NPI:1073933529
Name:SOPCZAK, ANTHONY (PA)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:SOPCZAK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:ANTHONY
Other - Middle Name:PATRICK
Other - Last Name:SOPCZAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:1320 DECATUR PIKE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-2418
Mailing Address - Country:US
Mailing Address - Phone:423-746-1423
Mailing Address - Fax:423-745-6413
Practice Address - Street 1:1320 DECATUR PIKE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-2418
Practice Address - Country:US
Practice Address - Phone:423-746-1412
Practice Address - Fax:423-745-6413
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1117328363AM0700X
TN3669363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical