Provider Demographics
NPI:1669489050
Name:COPE, ATYS BENJAMIN (MD)
Entity type:Individual
Prefix:
First Name:ATYS
Middle Name:BENJAMIN
Last Name:COPE
Suffix:
Gender:M
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:PO BOX 239
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-0239
Mailing Address - Country:US
Mailing Address - Phone:912-764-8080
Mailing Address - Fax:912-764-8083
Practice Address - Street 1:81 E JONES AVE
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-2919
Practice Address - Country:US
Practice Address - Phone:912-764-8080
Practice Address - Fax:912-764-8083
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052160207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA597816045AMedicaid
GA597816045AMedicaid
GA18BDGFPMedicare PIN