Provider Demographics
NPI:1205816212
Name:COPPER, CHAD MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:MICHAEL
Last Name:COPPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:725 JESSE JEWELL PKWY SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3834
Practice Address - Country:US
Practice Address - Phone:770-536-2323
Practice Address - Fax:770-536-4947
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055818208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA603854369BMedicaid
GA52170731OtherBCBS
GA603854369AMedicaid
GA10045077OtherAMERIGROUP
GA7385826OtherAETNA
GAP00246474OtherRR MEDICARE-GRP # CC4177
GA8411488OtherCIGNA
GA2548303OtherUNITED HEALTHCARE
GA340827OtherWELLCARE
I35998Medicare UPIN
GAP00246474OtherRR MEDICARE-GRP # CC4177