Healthcare Provider Details

I. General information

NPI: 1346712668
Provider Name (Legal Business Name): MS. MOLLY MARIE HOPKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2018
Last Update Date: 12/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 BLUE RIDGE TRCE
WOODSTOCK GA
30189-6296
US

IV. Provider business mailing address

440 ERNEST W BARRETT PKWY NW STE 31
KENNESAW GA
30144-4918
US

V. Phone/Fax

Practice location:
  • Phone: 770-378-3273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: