Healthcare Provider Details

I. General information

NPI: 1902893506
Provider Name (Legal Business Name): BRIAN SCOTT COPE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 TAYLOR ST STE 1A
COLUMBIA SC
29201-2946
US

IV. Provider business mailing address

PO BOX 743904
ATLANTA GA
30374-3904
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-4790
  • Fax: 803-434-4799
Mailing address:
  • Phone: 803-296-7320
  • Fax: 803-296-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number9600894
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number82684
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: