MEDICARE: COOPER ACADEMY INC.

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1699603381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COOPER ACADEMY INC.

Provider Business Mailing Address
First Line	:	4227 FRANKLIN MILL LN
Second Line	:
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-9701
Country	:	US
Telephone Number	:	678-609-8409
Fax Number	:

Provider Business Practice Location Address
First Line	:	4227 FRANKLIN MILL LN
Second Line	:
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-9701
Country	:	US
Telephone Number	:	678-609-8409
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DEMETREA COOPER
Credential	:
Telephone Number	:	803-616-6794

Provider Enumeration Date	:	05/12/2026
Last Update Date	:	05/12/2026

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Directions to “COOPER ACADEMY INC. ” Practice Location

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