Provider Demographics
NPI:1578779054
Name:POPE, MYRA MCCOY (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRA
Middle Name:MCCOY
Last Name:POPE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 LITTLE JOHN CT
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4124
Mailing Address - Country:US
Mailing Address - Phone:912-547-3150
Mailing Address - Fax:912-238-0637
Practice Address - Street 1:5 MALL ANX
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4738
Practice Address - Country:US
Practice Address - Phone:912-495-8887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020937208D00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00287504BMedicaid
GA00287504BMedicaid