Provider Demographics
NPI:1497827653
Name:POPP, MARY (RNFA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:POPP
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-5228
Mailing Address - Country:US
Mailing Address - Phone:404-351-0051
Mailing Address - Fax:404-351-0632
Practice Address - Street 1:332 KINGS HWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-5228
Practice Address - Country:US
Practice Address - Phone:404-351-0051
Practice Address - Fax:404-351-0632
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN148914363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner