Healthcare Provider Details

I. General information

NPI: 1962306654
Provider Name (Legal Business Name): SOPH LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 PAVILION PKWY STE 126
FAYETTEVILLE GA
30214-4065
US

IV. Provider business mailing address

200 LANDING DR
FAYETTEVILLE GA
30214-7616
US

V. Phone/Fax

Practice location:
  • Phone: 678-215-5211
  • Fax:
Mailing address:
  • Phone: 678-215-5211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNULL

VIII. Authorized Official

Name: KAMESHA HOPKINS
Title or Position: OWNER
Credential:
Phone: 678-215-5211