MEDICARE: AMY A COOPER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	047071	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235106048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY A COOPER MD

Provider Business Mailing Address
First Line	:	PO BOX 2258
Second Line	:
City	:	THOMASVILLE
State	:	GA
Zip	:	31799-2258
Country	:	US
Telephone Number	:	229-226-7544
Fax Number	:	229-226-0314

Provider Business Practice Location Address
First Line	:	509 GORDON AVE
Second Line	:
City	:	THOMASVILLE
State	:	GA
Zip	:	31792-6645
Country	:	US
Telephone Number	:	229-226-7544
Fax Number	:	229-226-0314

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	07/09/2007

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Directions to “ AMY A COOPER MD” Practice Location

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