Provider Demographics
NPI:1982811626
Name:PAUL R COPLIN MD PC
Entity Type:Organization
Organization Name:PAUL R COPLIN MD PC
Other - Org Name:PSYCHIATRIC HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:COPLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-923-3762
Mailing Address - Street 1:PO BOX 7737
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31095-7737
Mailing Address - Country:US
Mailing Address - Phone:478-923-3762
Mailing Address - Fax:478-923-2929
Practice Address - Street 1:1047 N HOUSTON RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-1505
Practice Address - Country:US
Practice Address - Phone:478-923-3762
Practice Address - Fax:478-923-2929
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAUL R COPLIN, MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-16
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA055000354AMedicaid
GAGRP-57Medicare PIN