Provider Demographics
NPI:1205591948
Name:POPP, MEGAN LARSEN (FNP-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:LARSEN
Last Name:POPP
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 NORTHSIDE FORSYTH DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7668
Mailing Address - Country:US
Mailing Address - Phone:770-898-8388
Mailing Address - Fax:770-898-8389
Practice Address - Street 1:1400 NORTHSIDE FORSYTH DR STE 200
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7668
Practice Address - Country:US
Practice Address - Phone:770-898-8388
Practice Address - Fax:770-898-8389
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN222482363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA071762605OtherDRIVERS LICENSE