Healthcare Provider Details

I. General information

NPI: 1669427316
Provider Name (Legal Business Name): MELANIE L COOPER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

578 S ENOTA DR NE STE C
GAINESVILLE GA
30501-8947
US

IV. Provider business mailing address

578 S ENOTA DR NE STE C
GAINESVILLE GA
30501-8947
US

V. Phone/Fax

Practice location:
  • Phone: 470-290-8474
  • Fax:
Mailing address:
  • Phone: 470-290-8474
  • Fax: 770-593-9447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number045753
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number045753
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: