Provider Demographics
NPI:1053339663
Name:SOPARAS, JOSEPH STANLEY (PA-C/L)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:STANLEY
Last Name:SOPARAS
Suffix:
Gender:M
Credentials:PA-C/L
Other - Prefix:
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Mailing Address - Street 1:1 FREEDOM WAY # 291
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-6258
Mailing Address - Country:US
Mailing Address - Phone:706-733-0188
Mailing Address - Fax:706-481-6703
Practice Address - Street 1:1 FREEDOM WAY # 291
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6258
Practice Address - Country:US
Practice Address - Phone:706-733-0188
Practice Address - Fax:706-481-6703
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA001714363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical