Provider Demographics
NPI:1336683838
Name:POPE, LORI (NP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:POPE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 AMBULANCE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3857
Mailing Address - Country:US
Mailing Address - Phone:770-812-2650
Mailing Address - Fax:
Practice Address - Street 1:204 ALLEN MEMORIAL DR STE 201
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:GA
Practice Address - Zip Code:30110-2062
Practice Address - Country:US
Practice Address - Phone:770-537-6500
Practice Address - Fax:770-824-2600
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN135403363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily