Healthcare Provider Details

I. General information

NPI: 1215336185
Provider Name (Legal Business Name): ROBIN COPELAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2014
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 LAKESIDE DR
LYNCHBURG VA
24501-3113
US

IV. Provider business mailing address

1501 LAKESIDE DR
LYNCHBURG VA
24501-3113
US

V. Phone/Fax

Practice location:
  • Phone: 678-698-1323
  • Fax:
Mailing address:
  • Phone: 678-698-1323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: