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General NPI Number Information
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NPI Number | 1164646659
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Entity Type | Individual
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Provider Name | TERRI KOPP NP
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Gender | Female
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 04/15/2019
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Provider Practice Location Address
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Address Line | 3535 HIGHWAY 81
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City | LOGANVILLE
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State | GA
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Zip | 30052-4336
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Country | US
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Telephone | 678-905-9625
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Fax |
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Provider Business Mailing Address
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Address Line | 3535 HIGHWAY 81
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City | LOGANVILLE
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State | GA
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Zip | 30052-4336
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Country | US
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Telephone | 678-905-9625
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Fax | 770-674-5880
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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 | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | ARNP9370385
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP30007423
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 20340
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9370385
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN270748
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License Number State | GA
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