Provider Demographics
NPI:1114364643
Name:FOPPE, JAMIE ELISE (DPT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:ELISE
Last Name:FOPPE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:ELISE
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:3455 PEACHTREE PKWY
Practice Address - Street 2:STE 206
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-9104
Practice Address - Country:US
Practice Address - Phone:678-473-1081
Practice Address - Fax:678-473-1082
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT010996OtherPHYSICAL THERAPIST LICENSE