Healthcare Provider Details

I. General information

NPI: 1932020088
Provider Name (Legal Business Name): NICHOLAS MAWUENA JOPPA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

1399 WALTON WAY APT 101
AUGUSTA GA
30901-2680
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-1244
  • Fax:
Mailing address:
  • Phone: 706-267-1409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number114225
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: