Healthcare Provider Details

I. General information

NPI: 1992334866
Provider Name (Legal Business Name): CHELSAE PATRICIA KOPP MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSAE PATRICIA DORENBUSH MD

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S 8TH ST FL 3
GRIFFIN GA
30224-4213
US

IV. Provider business mailing address

601 S 8TH ST
GRIFFIN GA
30224-4213
US

V. Phone/Fax

Practice location:
  • Phone: 470-935-4047
  • Fax: 470-935-6191
Mailing address:
  • Phone: 470-935-4045
  • Fax: 470-935-6191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number96088
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: