Provider Demographics
NPI:1689119299
Name:ROPER, EMILY GRIFFIN (RN, APNP, PNP)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:GRIFFIN
Last Name:ROPER
Suffix:
Gender:F
Credentials:RN, APNP, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 SUGARLOAF PKWY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-5403
Mailing Address - Country:US
Mailing Address - Phone:678-377-1113
Mailing Address - Fax:
Practice Address - Street 1:3525 SUGARLOAF PKWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-5403
Practice Address - Country:US
Practice Address - Phone:678-377-1113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-05
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN224032363LP2300X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1689119299Medicaid