Provider Demographics
NPI:1902962855
Name:POPLAR PHYSICIANS, LLC
Entity Type:Organization
Organization Name:POPLAR PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:478-746-1218
Mailing Address - Street 1:446 POPLAR ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-3336
Mailing Address - Country:US
Mailing Address - Phone:478-746-1218
Mailing Address - Fax:478-750-9594
Practice Address - Street 1:446 POPLAR ST
Practice Address - Street 2:SUITE B
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-3336
Practice Address - Country:US
Practice Address - Phone:478-746-1218
Practice Address - Fax:478-750-9594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACE0448OtherRAILROAD MEDICARE
GAGRP2957Medicare PIN