Provider Demographics
NPI:1508457243
Name:COPELAND, TIESHA C
Entity Type:Individual
Prefix:PROF
First Name:TIESHA
Middle Name:C
Last Name:COPELAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 COOPER RD
Mailing Address - Street 2:
Mailing Address - City:CLIMAX
Mailing Address - State:GA
Mailing Address - Zip Code:39834-2405
Mailing Address - Country:US
Mailing Address - Phone:229-205-1482
Mailing Address - Fax:
Practice Address - Street 1:164 COOPER RD
Practice Address - Street 2:
Practice Address - City:CLIMAX
Practice Address - State:GA
Practice Address - Zip Code:39834-2405
Practice Address - Country:US
Practice Address - Phone:229-205-1482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty