Provider Demographics
NPI:1962651760
Name:ROPER, CYNTHIA LAREE
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LAREE
Last Name:ROPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:LAREE
Other - Last Name:ROPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PERSONAL CARE HOME
Mailing Address - Street 1:6706 SAVANNAH HWY
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:GA
Mailing Address - Zip Code:30467-9320
Mailing Address - Country:US
Mailing Address - Phone:912-857-6591
Mailing Address - Fax:912-857-6591
Practice Address - Street 1:6706 SAVANNAH HWY
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:GA
Practice Address - Zip Code:30467-9320
Practice Address - Country:US
Practice Address - Phone:912-857-6591
Practice Address - Fax:912-857-6591
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA124-01-018-9172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker