1104952407 NPI number — DR. SETH A POPE M.D., P.C.

Table of content: DR. SETH A POPE M.D., P.C. (NPI 1104952407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104952407 NPI number — DR. SETH A POPE M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POPE
Provider First Name:
SETH
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., P.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104952407
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2150 PEACHFORD RD
Provider Second Line Business Mailing Address:
SUITE Q
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30338-6520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-455-1277
Provider Business Mailing Address Fax Number:
770-451-6130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2150 PEACHFORD RD
Provider Second Line Business Practice Location Address:
SUITE Q
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30338-6520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-455-1277
Provider Business Practice Location Address Fax Number:
770-451-6130
Provider Enumeration Date:
02/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  023710 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000336267B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10039389 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 52238055 . This is a "BCBS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 260050958 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 0000744 . This is a "VALUE OPTIONS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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