Provider Demographics
NPI:1356475180
Name:POPE, AMY S (MS RD CDE)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:S
Last Name:POPE
Suffix:
Gender:F
Credentials:MS RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 TAYLOR STREET SUITE 4 E
Mailing Address - Street 2:PALMETTO HEALTH BAPTIST DIABETES EDUCATION
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2923
Mailing Address - Country:US
Mailing Address - Phone:803-296-3956
Mailing Address - Fax:803-296-8908
Practice Address - Street 1:1333 TAYLOR STREET SUITE 4 E
Practice Address - Street 2:PALMETTO HEALTH BAPTIST DIABETES EDUCATION
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2923
Practice Address - Country:US
Practice Address - Phone:803-296-3956
Practice Address - Fax:803-296-8908
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC847717133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDPE037Medicaid