Provider Demographics
NPI:1295183382
Name:COPELAND, MARISSA GAIL (DO)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:GAIL
Last Name:COPELAND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 E GREENVILLE ST STE 1600
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1719
Mailing Address - Country:US
Mailing Address - Phone:864-226-9193
Mailing Address - Fax:864-231-0281
Practice Address - Street 1:2000 E GREENVILLE ST STE 1600
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1719
Practice Address - Country:US
Practice Address - Phone:864-226-9193
Practice Address - Fax:864-231-0281
Is Sole Proprietor?:No
Enumeration Date:2016-05-30
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL39234207Q00000X
SCDO39234207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine