Provider Demographics
NPI:1700269958
Name:POPWELL, COURTNEY MARIE (DNP)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MARIE
Last Name:POPWELL
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:MARIE
Other - Last Name:HERNDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:218 QUARTERMAN ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-3547
Mailing Address - Country:US
Mailing Address - Phone:912-287-0301
Mailing Address - Fax:912-287-1568
Practice Address - Street 1:711 CHARLES GILMAN JR AVE STE B
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-5664
Practice Address - Country:US
Practice Address - Phone:912-510-9728
Practice Address - Fax:912-510-9752
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN197793363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily