Basic Information
| Provider Information | |||||||||
| NPI: | 1578779054 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POPE | ||||||||
| FirstName: | MYRA | ||||||||
| MiddleName: | MCCOY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2507 LITTLE JOHN CT | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314064124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125473150 | ||||||||
| FaxNumber: | 9122380637 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 MALL ANX | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314064738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9124958887 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 05/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 020937 | GA | Y | Allopathic & Osteopathic Physicians | General Practice | 207QH0002X | 020937 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00287504B | 05 | GA | MEDICAID |