Provider Demographics
NPI:1285602938
Name:COPELAND, CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:COPELAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 HERITAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-4241
Mailing Address - Country:US
Mailing Address - Phone:423-623-7043
Mailing Address - Fax:423-623-7046
Practice Address - Street 1:330 HERITAGE BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-4241
Practice Address - Country:US
Practice Address - Phone:423-623-7043
Practice Address - Fax:523-623-7046
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14957207L00000X, 207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3007198Medicaid
TN4020552OtherBLUECARE
TN100021014OtherPHP TENNCARE
TN050083452OtherTRAVELERS MEDICARE
TN4020552OtherBLUE CROSS
TN050083452OtherTRAVELERS MEDICARE
TN4020552OtherBLUE CROSS