Provider Demographics
NPI:1659097079
Name:CHAMPION, HOPE CONWAY (APRN)
Entity Type:Individual
Prefix:
First Name:HOPE
Middle Name:CONWAY
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3607 KELSEY CHASE CT
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7575
Mailing Address - Country:US
Mailing Address - Phone:407-853-1159
Mailing Address - Fax:
Practice Address - Street 1:3607 KELSEY CHASE CT
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7575
Practice Address - Country:US
Practice Address - Phone:407-853-1159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2023-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL660919363LF0000X
FLAPRN11023024207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11023024Medicaid
GAGAA-NP001549OtherGEORGIA NP LICENSE