Healthcare Provider Details

I. General information

NPI: 1386172948
Provider Name (Legal Business Name): JESSICA POPLAWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2077 HARBOR BLVD STE 100
COSTA MESA CA
92627-9384
US

IV. Provider business mailing address

1120 15TH ST
AUGUSTA GA
30912-0004
US

V. Phone/Fax

Practice location:
  • Phone: 949-740-7117
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number82542
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: