Healthcare Provider Details

I. General information

NPI: 1306325428
Provider Name (Legal Business Name): CARRIE A LOPER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE
ATLANTA GA
30322-1059
US

IV. Provider business mailing address

684 SIXES RD STE 235
HOLLY SPRINGS GA
30115-8722
US

V. Phone/Fax

Practice location:
  • Phone: 404-686-2316
  • Fax:
Mailing address:
  • Phone: 678-388-6500
  • Fax: 678-388-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8928
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number008928
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: