# MR. JESSIE LEE COPELAND JR.

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1164412474
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207P00000X | Emergency Medicine Physician | 30843 | TN | — |
| 207R00000X | Internal Medicine Physician | MD30843 | TN | — |
| 207RA0000X | Adolescent Medicine (Internal Medicine) Physician | MD30843 | TN | Yes |
| 208M00000X | Hospitalist Physician | 30843 | TN | — |

## Other

- **Enumeration date:** 10/27/2005
- **Last updated:** 09/19/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 141913142 | TAX ID | TN |
| 05 | — | 1510372 | — | TN |
| 05 | — | 3726598 | — | TN |
| 05 | — | 3837472 | — | TN |
| 01 | — | P00162052 | RAILROAD MEDICARE | TN |