Healthcare Provider Details

I. General information

NPI: 1205943701
Provider Name (Legal Business Name): TODD M COOPER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVE S
BIRMINGHAM AL
35233-1711
US

IV. Provider business mailing address

2015 UPPERGATE DR
ATLANTA GA
30322-0001
US

V. Phone/Fax

Practice location:
  • Phone: 205-939-9285
  • Fax: 205-975-6377
Mailing address:
  • Phone: 404-785-1200
  • Fax: 404-785-1879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberDO-646
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number061411
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: