=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437589678
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THERESA Y POPAS NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2013
-----------------------------------------------------
Last Update Date | 04/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 725 GLENWOOD DR STE E780
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37404-1177
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-697-0072
-----------------------------------------------------
Fax | 423-697-1798
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 725 GLENWOOD DR STE E780
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37404-1177
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-697-0072
-----------------------------------------------------
Fax | 423-697-1798
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 18128
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------