Healthcare Provider Details

I. General information

NPI: 1639645120
Provider Name (Legal Business Name): POPHEALTHCARE MEDICAL SERVICES OF GA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 SEABOARD LN STE 200B
FRANKLIN TN
37067-8282
US

IV. Provider business mailing address

113 SEABOARD LN STE 200B
FRANKLIN TN
37067-8282
US

V. Phone/Fax

Practice location:
  • Phone: 615-721-7020
  • Fax:
Mailing address:
  • Phone: 615-721-7020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SONJA BOX BEATY
Title or Position: VP OPERATIONS
Credential:
Phone: 800-793-7050