Healthcare Provider Details

I. General information

NPI: 1447965900
Provider Name (Legal Business Name): JASMINE COOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 FURYS FERRY RD
AUGUSTA GA
30907-4728
US

IV. Provider business mailing address

1212 AUGUSTA WEST PKWY STE 1B
AUGUSTA GA
30909-1808
US

V. Phone/Fax

Practice location:
  • Phone: 706-826-2770
  • Fax: 706-826-2771
Mailing address:
  • Phone: 706-826-2770
  • Fax: 706-826-2771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA003131
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: