Provider Demographics
NPI:1104952407
Name:POPE, SETH A (MD, PC)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:A
Last Name:POPE
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 PEACHFORD RD
Mailing Address - Street 2:SUITE Q
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6520
Mailing Address - Country:US
Mailing Address - Phone:770-455-1277
Mailing Address - Fax:770-451-6130
Practice Address - Street 1:2150 PEACHFORD RD
Practice Address - Street 2:SUITE Q
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6520
Practice Address - Country:US
Practice Address - Phone:770-455-1277
Practice Address - Fax:770-451-6130
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0237102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000336267BMedicaid
GA10039389OtherAMERIGROUP
GA52238055OtherBCBS
GA260050958OtherRAILROAD MEDICARE
GA0000744OtherVALUE OPTIONS
GAD40884Medicare UPIN