MEDICARE: MRS. ZAKIYA MONIQUE WILLIS-COPELAND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1356162325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ZAKIYA MONIQUE WILLIS-COPELAND

Provider Business Mailing Address
First Line	:	290 HILDERBRAND DR STE B8
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-3912
Country	:	US
Telephone Number	:	706-512-8100
Fax Number	:

Provider Business Practice Location Address
First Line	:	290 HILDERBRAND DR STE B8
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-3912
Country	:	US
Telephone Number	:	706-512-8100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2024
Last Update Date	:	10/22/2024

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