Healthcare Provider Details

I. General information

NPI: 1053345025
Provider Name (Legal Business Name): COOPER MEDICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 RALPH DAVID ABERNATHY BLVD SW #2
ATLANTA GA
30312-2404
US

IV. Provider business mailing address

448 RALPH DAVID ABERNATHY BLVD SW #2
ATLANTA GA
30312-2404
US

V. Phone/Fax

Practice location:
  • Phone: 678-499-8633
  • Fax: 404-522-0703
Mailing address:
  • Phone: 678-499-8633
  • Fax: 404-522-0703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KIERAN A COOPER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 678-499-8633