Healthcare Provider Details

I. General information

NPI: 1972123420
Provider Name (Legal Business Name): WILLIAM CHASE COOPER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 19TH ST S
BIRMINGHAM AL
35233-1900
US

IV. Provider business mailing address

1420 18TH ST S APT I
BIRMINGHAM AL
35205-6221
US

V. Phone/Fax

Practice location:
  • Phone: 205-283-1305
  • Fax:
Mailing address:
  • Phone: 205-283-1305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number1-173675
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: