Healthcare Provider Details

I. General information

NPI: 1164956215
Provider Name (Legal Business Name): OLIVIA ZOPH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2017
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 JESSE HILL JR DR SE SUITE 310
ATLANTA GA
30303-3049
US

IV. Provider business mailing address

317 W HOLLY ST
PHOENIX AZ
85003-1116
US

V. Phone/Fax

Practice location:
  • Phone: 404-251-8866
  • Fax:
Mailing address:
  • Phone: 623-764-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number70589
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: