Basic Information
| Provider Information | |||||||||
| NPI: | 1548823701 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COPPIANO | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | STEPHEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2846 WALTON WAY APT 38 | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309095219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6785212484 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1120 15TH ST | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309120006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067210211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2019 | ||||||||
| LastUpdateDate: | 04/15/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 10807 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.