Provider Demographics
NPI:1689627556
Name:COPLEY, SUSAN KATHLEEN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KATHLEEN
Last Name:COPLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4461 COUNTY ROAD 411
Mailing Address - Street 2:
Mailing Address - City:GROVEOAK
Mailing Address - State:AL
Mailing Address - Zip Code:35975-4843
Mailing Address - Country:US
Mailing Address - Phone:256-623-6127
Mailing Address - Fax:
Practice Address - Street 1:201 PINE ST NW
Practice Address - Street 2:
Practice Address - City:HARTSELLE
Practice Address - State:AL
Practice Address - Zip Code:35640-2309
Practice Address - Country:US
Practice Address - Phone:904-805-1300
Practice Address - Fax:904-805-1302
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18715207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51555571OtherBLUE CROSS
AL051552917Medicaid
AL009943023Medicaid
AL009943023Medicaid
AL051552917Medicaid