Healthcare Provider Details

I. General information

NPI: 1629061494
Provider Name (Legal Business Name): CATHERINE COOLEY N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 HOGANSVILLE RD
LAGRANGE GA
30241-6600
US

IV. Provider business mailing address

356 JOHN LOVELACE RD
LAGRANGE GA
30241-9547
US

V. Phone/Fax

Practice location:
  • Phone: 706-298-7250
  • Fax:
Mailing address:
  • Phone: 706-882-7461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN043302
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: