Provider Demographics
NPI:1568567378
Name:POPE CHOICE MEDICAL, DAMON
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:
Last Name:POPE CHOICE MEDICAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4774 LAMB AVE
Mailing Address - Street 2:
Mailing Address - City:UNION POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30669-1121
Mailing Address - Country:US
Mailing Address - Phone:706-486-0055
Mailing Address - Fax:
Practice Address - Street 1:4774 LAMB AVE
Practice Address - Street 2:
Practice Address - City:UNION POINT
Practice Address - State:GA
Practice Address - Zip Code:30669-1121
Practice Address - Country:US
Practice Address - Phone:706-486-0055
Practice Address - Fax:706-486-0060
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5555890001Medicare NSC