Healthcare Provider Details

I. General information

NPI: 1336683838
Provider Name (Legal Business Name): LORI POPE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 10/12/2025
Certification Date: 10/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CLINIC AVE STE 101
CARROLLTON GA
30117-4402
US

IV. Provider business mailing address

150 CLINIC AVE STE 101
CARROLLTON GA
30117-4402
US

V. Phone/Fax

Practice location:
  • Phone: 770-834-0873
  • Fax:
Mailing address:
  • Phone: 770-834-0873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN135403
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: