Provider Demographics
NPI:1306255617
Name:POPOVICI, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:POPOVICI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 COTTONWOOD CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-9006
Mailing Address - Country:US
Mailing Address - Phone:678-608-5201
Mailing Address - Fax:
Practice Address - Street 1:342 COTTONWOOD CREEK CIR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-9006
Practice Address - Country:US
Practice Address - Phone:678-608-5201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3581146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic