MEDICARE: CATHERINE COOLEY N.P.

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	363LW0102X	Women's Health Nurse Practitioner	RN043302	GA

General Provider Information

NPI Number	:	1629061494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE COOLEY N.P.

Provider Business Mailing Address
First Line	:	356 JOHN LOVELACE RD
Second Line	:
City	:	LAGRANGE
State	:	GA
Zip	:	30241-9547
Country	:	US
Telephone Number	:	706-882-7461
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 HOGANSVILLE RD
Second Line	:
City	:	LAGRANGE
State	:	GA
Zip	:	30241-6600
Country	:	US
Telephone Number	:	706-298-7250
Fax Number	:

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	01/21/2014

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