Active NPI
Reginald Copeland, M.DIV., LCC., M.ED
- Contractor
- Marietta, GA
National Provider Identifier
1336697267
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- Practice address
- 412 Fort St NE
Marietta, GA 30060-1777 - Phone
- (562) 618-0877
- NPI assigned
- Sep 20, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | Primary |
Addresses
Primary practice location
412 Fort St NE
Marietta, GA 30060-1777
Mailing address
412 Fort St NE
Marietta, GA 30060-1777
Phone (562) 618-0877
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1474329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1474329600000",
"number": "1336697267",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "412 FORT ST NE",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300601777",
"telephone_number": "562-618-0877"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "412 FORT ST NE",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300601777",
"telephone_number": "562-618-0877"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COPELAND",
"first_name": "REGINALD",
"credential": "M.DIV., LCC., M.ED",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-09-20",
"last_updated": "2016-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.