Individual
ALYSSA NICOLE KOOPAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1712A E BROAD AVE, ALBANY, GA 31705-2611
(229) 639-3100
Mailing address
142 PLANTATION DR, LEESBURG, GA 31763-4284
(310) 650-2839
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9443
GA
Other
Enumeration date
10/22/2018
Last updated
10/24/2022
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