Individual
MR. JESSIE LEE COPELAND JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
110 DOCTORS DR, CELINA, TN 38551
(931) 243-3860
(931) 243-4607
Mailing address
PO BOX 388, CELINA, TN 38551-0388
(931) 243-3860
(931) 243-4607
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
30843
TN
207R00000X
Internal Medicine Physician
MD30843
TN
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
Primary
MD30843
TN
208M00000X
Hospitalist Physician
30843
TN
Other
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
Enumeration date
10/27/2005
Last updated
09/19/2019
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