Provider Demographics
NPI:1538387626
Name:COPLIN, SHANNON ROBERT (PA)
Entity type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:ROBERT
Last Name:COPLIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 CHRISTINE AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-4657
Mailing Address - Country:US
Mailing Address - Phone:256-237-0025
Mailing Address - Fax:256-237-4795
Practice Address - Street 1:1129 CHRISTINE AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4657
Practice Address - Country:US
Practice Address - Phone:256-237-0025
Practice Address - Fax:256-237-4795
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA69363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant