Provider Demographics
NPI:1629618806
Name:KOPSICK, CHRISTINA RENEE (NP)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:RENEE
Last Name:KOPSICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:RENEE
Other - Last Name:KOPSICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:11340 LAKEFIELD DR STE 200
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-2456
Mailing Address - Country:US
Mailing Address - Phone:888-515-3834
Mailing Address - Fax:386-603-0327
Practice Address - Street 1:11340 LAKEFIELD DR STE 200
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-2456
Practice Address - Country:US
Practice Address - Phone:888-515-3834
Practice Address - Fax:386-603-0327
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN222346363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily