Healthcare Provider Details

I. General information

NPI: 1386849040
Provider Name (Legal Business Name): COPELAND MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 DOCTORS DRIVE
CELINA TN
38551
US

IV. Provider business mailing address

110 DOCTORS DRIVE
CELINA TN
38551
US

V. Phone/Fax

Practice location:
  • Phone: 931-243-3860
  • Fax: 931-243-4607
Mailing address:
  • Phone: 931-243-3860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JESSIE LEE COPELAND
Title or Position: OWNER
Credential: MD
Phone: 931-243-3860