Provider Demographics
NPI:1912906199
Name:COPELAND, ALBERT D JR (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:D
Last Name:COPELAND
Suffix:JR
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 1:1909 US HIGHWAY 82 W STE 3&4
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-8200
Mailing Address - Country:US
Mailing Address - Phone:229-445-3509
Mailing Address - Fax:229-445-3513
Practice Address - Street 1:1909 US HIGHWAY 82 W STE 3&4
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31793-8200
Practice Address - Country:US
Practice Address - Phone:229-445-3509
Practice Address - Fax:229-445-3513
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031400208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL199322Medicaid
GA000385074AUMedicaid
GAE19878Medicare UPIN
AL199322Medicaid