Provider Demographics
NPI:1356693279
Name:JOSEPH P KROPP, P.C.
Entity type:Organization
Organization Name:JOSEPH P KROPP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MYRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-489-8787
Mailing Address - Street 1:108 S ZETTEROWER AVE
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-4816
Mailing Address - Country:US
Mailing Address - Phone:912-498-8787
Mailing Address - Fax:912-489-6603
Practice Address - Street 1:108 S ZETTEROWER AVE
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-4816
Practice Address - Country:US
Practice Address - Phone:912-498-8787
Practice Address - Fax:912-489-6603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY0011702261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000596703AMedicaid