Provider Demographics
NPI:1881045128
Name:POPE, AMANDA FLY (ATC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:FLY
Last Name:POPE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 CORNELSON DR
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-1264
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:315 MEDICAL PKWY
Practice Address - Street 2:STE 100
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-2456
Practice Address - Country:US
Practice Address - Phone:864-454-7422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1030207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine