=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225984412
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIARA NICHOLE LOPER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2026
-----------------------------------------------------
Last Update Date | 03/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30 CHATEAU DR SE
-----------------------------------------------------
City | ROME
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30161-7201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-291-3620
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9696 YELLOW PINE RD
-----------------------------------------------------
City | MIDLAND
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31820-4151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 589071
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------