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General NPI Number Information
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NPI Number | 1003673302
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Entity Type | Individual
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Provider Name | NATHAN EDWARD POPHAM LCSW, LICSW
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Gender | Male
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Dates
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Enumeration Date | 03/04/2024
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 308 3RD ST E
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City | FRUITHURST
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State | AL
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Zip | 36262-3751
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Country | US
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Telephone | 256-926-8797
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Fax |
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Provider Business Mailing Address
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Address Line | 308 3RD ST E
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City | FRUITHURST
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State | AL
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Zip | 36262-3751
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Country | US
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Telephone | 256-926-8797
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW007489
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4618C
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License Number State | AL
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