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General NPI Number Information
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NPI Number | 1124293089
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Entity Type | Individual
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Provider Name | DAVID MICHAEL POPOLI M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 07/19/2012
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Provider Practice Location Address
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Address Line | 1265 HIGHWAY 54 W STE 200
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-4543
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Country | US
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Telephone | 404-785-8790
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Fax |
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Provider Business Mailing Address
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Address Line | 1265 HIGHWAY 54 W STE 200
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-4543
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Country | US
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Telephone | 404-785-8790
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 242731
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 67960
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License Number State | GA
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