MEDICARE: DR. RENATO POPOVIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1013525120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENATO POPOVIC

Provider Business Mailing Address
First Line	:	6635 BASS ROAD
Second Line	:
City	:	FORT BENNING
State	:	GA
Zip	:	31905
Country	:	US
Telephone Number	:	800-214-8387
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 CROSS COUNTRY DR
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-1801
Country	:	US
Telephone Number	:	706-568-7628
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2020
Last Update Date	:	01/06/2021

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Directions to “ DR. RENATO POPOVIC ” Practice Location

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