Provider Demographics
NPI:1265413124
Name:COPELAND, SAGE KINNEY (MD, FACS)
Entity type:Individual
Prefix:DR
First Name:SAGE
Middle Name:KINNEY
Last Name:COPELAND
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 13TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4307
Mailing Address - Country:US
Mailing Address - Phone:256-355-6200
Mailing Address - Fax:256-355-6241
Practice Address - Street 1:1218 13TH AVE SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4307
Practice Address - Country:US
Practice Address - Phone:256-355-6200
Practice Address - Fax:256-355-6241
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00011018207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000019326Medicaid
AL040011769OtherRAILROAD MEDICARE
AL510-19326OtherBCBS
AL051019326OtherPROVIDER NUMBER
AL000019326Medicaid
AL051019326OtherPROVIDER NUMBER