Provider Demographics
NPI:1437124385
Name:KOPACKA, JEANNE L (PA)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:L
Last Name:KOPACKA
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:5671 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-5000
Mailing Address - Country:US
Mailing Address - Phone:404-847-9999
Mailing Address - Fax:404-531-8466
Practice Address - Street 1:2000 HOWARD FARM DR STE 200
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6081
Practice Address - Country:US
Practice Address - Phone:770-292-6500
Practice Address - Fax:770-292-6535
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2019-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA002005363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA806351077BMedicaid
GA806351077AMedicaid
GAR55682Medicare UPIN
GA806351077BMedicaid