Healthcare Provider Details

I. General information

NPI: 1083811459
Provider Name (Legal Business Name): JESANNA CAROLAN COOPER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 PRINCETON AVE SW
BIRMINGHAM AL
35211-1320
US

IV. Provider business mailing address

PO BOX 12366
BIRMINGHAM AL
35202-2366
US

V. Phone/Fax

Practice location:
  • Phone: 205-206-8477
  • Fax: 205-397-0986
Mailing address:
  • Phone: 205-780-7101
  • Fax: 205-206-8338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number28204
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: