Healthcare Provider Details

I. General information

NPI: 1285706622
Provider Name (Legal Business Name): MICHAEL C POPE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 EASTBROOK BND SUITE A
PEACHTREE CITY GA
30269-1530
US

IV. Provider business mailing address

8 EASTBROOK BND SUITE A
PEACHTREE CITY GA
30269-1530
US

V. Phone/Fax

Practice location:
  • Phone: 770-487-5540
  • Fax: 770-487-4531
Mailing address:
  • Phone: 770-487-5540
  • Fax: 770-487-4531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN012203
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: