Individual
MACY MALCOM COPELAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
179 GARRETT WAY NW, MILLEDGEVILLE, GA 31061-2318
(478) 453-3004
Mailing address
179 GARRETT WAY NW, MILLEDGEVILLE, GA 31061-2318
(478) 453-3004
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN016074
GA
390200000X
Student in an Organized Health Care Education/Training Program
DN016074
GA
390200000X
Student in an Organized Health Care Education/Training Program
FC9804229
GA
Other
Enumeration date
02/27/2020
Last updated
08/19/2021
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