Healthcare Provider Details

I. General information

NPI: 1922822717
Provider Name (Legal Business Name): CHARMA LOU DALOPE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2024
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 DAN PROCTOR DR STE 3800
SAINT MARYS GA
31558-3894
US

IV. Provider business mailing address

2060 DAN PROCTOR DR STE 3800
SAINT MARYS GA
31558-3894
US

V. Phone/Fax

Practice location:
  • Phone: 912-540-6802
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN302952
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: