Provider Demographics
NPI:1366694051
Name:COPELAND, SANDRA D (NP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:D
Last Name:COPELAND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 MCCRACKIN ST
Mailing Address - Street 2:
Mailing Address - City:JULIETTE
Mailing Address - State:GA
Mailing Address - Zip Code:31046-4520
Mailing Address - Country:US
Mailing Address - Phone:478-994-3683
Mailing Address - Fax:
Practice Address - Street 1:101 HOUSTON ST
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30204-1660
Practice Address - Country:US
Practice Address - Phone:770-358-1961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN102110363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily