Healthcare Provider Details

I. General information

NPI: 1629335906
Provider Name (Legal Business Name): JACQUELINE HALL COOPER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1354 CLEVELAND AVE
EAST POINT GA
30344-3431
US

IV. Provider business mailing address

9879 MILTON CT
DOUGLASVILLE GA
30135-7628
US

V. Phone/Fax

Practice location:
  • Phone: 404-763-0405
  • Fax: 404-763-4223
Mailing address:
  • Phone: 856-287-9461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberGAA-NP001048
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ0036900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP012024
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: