Healthcare Provider Details

I. General information

NPI: 1780845198
Provider Name (Legal Business Name): BENJAMIN TAYLOR KOPP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 TULLIE RD NE
ATLANTA GA
30329-2309
US

IV. Provider business mailing address

2015 UPPERGATE DRIVE
ATLANTA GA
30322-2664
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-5830
  • Fax:
Mailing address:
  • Phone: 614-722-4750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number35-091073
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number92723
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: