Provider Demographics
NPI:1881629996
Name:POPPER, GEORGE P (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:P
Last Name:POPPER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1156
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28111-1156
Mailing Address - Country:US
Mailing Address - Phone:704-238-9011
Mailing Address - Fax:704-238-9891
Practice Address - Street 1:107 E. FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4850
Practice Address - Country:US
Practice Address - Phone:704-238-9011
Practice Address - Fax:704-238-9891
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5105103T00000X
NC3134103TC0700X, 103TF0200X, 103TM1800X
NCHSP-P3134103T00000X
NY103TS0200X
NC103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000792Medicaid
NC2822619AMedicare UPIN
NC2822619AMedicare PIN