MEDICARE: DR. JUSTIN COOPER JEX D.P.M.

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	213E00000X	Podiatrist	POD001259	GA
2	213E00000X	Podiatrist	1655	TX
3	213E00000X	Podiatrist	828	TN

General Provider Information

NPI Number	:	1437187390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN COOPER JEX D.P.M.

Provider Business Mailing Address
First Line	:	397 WALLACE RD STE 311
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37211-8027
Country	:	US
Telephone Number	:	615-712-7366
Fax Number	:

Provider Business Practice Location Address
First Line	:	397 WALLACE RD STE 311
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37211-8027
Country	:	US
Telephone Number	:	615-712-7366
Fax Number	:	615-712-7858

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	03/17/2018

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