=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134087323
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NAILAH ASHA COPELAND
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2026
-----------------------------------------------------
Last Update Date | 01/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11132 MEDLOCK BRIDGE RD
-----------------------------------------------------
City | JOHNS CREEK
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30097-1532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-406-6975
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4780 ASHFORD DUNWOODY RD # 289
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30338-5564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-852-4923
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224P00000X
-----------------------------------------------------
Taxonomy Name | Prosthetist
-----------------------------------------------------
License Number | 051907724
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------