Provider Demographics
NPI:1346204724
Name:COPPAGE, A TAYLOR III (MD)
Entity type:Individual
Prefix:
First Name:A
Middle Name:TAYLOR
Last Name:COPPAGE
Suffix:III
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 1:650 COLISEUM PL
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-3867
Mailing Address - Country:US
Mailing Address - Phone:478-745-7935
Mailing Address - Fax:478-745-7806
Practice Address - Street 1:650 COLISEUM PL
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3867
Practice Address - Country:US
Practice Address - Phone:478-745-7935
Practice Address - Fax:478-745-7806
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15854207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00016937DMedicaid
GAD29174Medicare UPIN