Provider Demographics
NPI:1669169371
Name:POPOVICI, GENNESIS CHRISTINA (MS, APC)
Entity type:Individual
Prefix:
First Name:GENNESIS
Middle Name:CHRISTINA
Last Name:POPOVICI
Suffix:
Gender:F
Credentials:MS, APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5239 PONDEROSA FARM RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30507-8719
Mailing Address - Country:US
Mailing Address - Phone:770-885-5550
Mailing Address - Fax:
Practice Address - Street 1:1400 BUFORD HWY STE R1
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-8777
Practice Address - Country:US
Practice Address - Phone:678-541-5096
Practice Address - Fax:678-541-5186
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008581101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health