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1538376942

NPI Code Detail

MEDICARE: DR. MARTHA LOUISE COOPER M.D.

MEDICARE: DR. MARTHA LOUISE COOPER M.D.

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	207Q00000X	Family Medicine Physician	BC4653247	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00242174	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	52623456004	OTHER	GA	BCBS OF GEORGIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538376942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTHA LOUISE COOPER M.D.

Provider Business Mailing Address
First Line	:	807 S ISABELLA ST
Second Line	:
City	:	SYLVESTER
State	:	GA
Zip	:	31791-7554
Country	:	US
Telephone Number	:	229-776-9143
Fax Number	:

Provider Business Practice Location Address
First Line	:	807 S ISABELLA ST
Second Line	:
City	:	SYLVESTER
State	:	GA
Zip	:	31791-7554
Country	:	US
Telephone Number	:	229-776-9143
Fax Number	:

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	10/21/2008

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Directions to “ DR. MARTHA LOUISE COOPER M.D.” Practice Location

Language	Start Address	Practice Location

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