Healthcare Provider Details

I. General information

NPI: 1194399402
Provider Name (Legal Business Name): ROYCE COPELAND DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 HOSPITAL PARK
MOULTRIE GA
31768-6772
US

IV. Provider business mailing address

PO BOX 2876
MOULTRIE GA
31776-2876
US

V. Phone/Fax

Practice location:
  • Phone: 229-891-9548
  • Fax:
Mailing address:
  • Phone: 229-502-9681
  • Fax: 229-891-9130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number111368
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number111368
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: