Healthcare Provider Details

I. General information

NPI: 1659709152
Provider Name (Legal Business Name): COOPERATIVE HEALTHCARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2013
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 DAN PROCTOR DR SUITE 140
SAINT MARYS GA
31558-3811
US

IV. Provider business mailing address

2040 DAN PROCTOR DR SUITE 140
SAINT MARYS GA
31558-3811
US

V. Phone/Fax

Practice location:
  • Phone: 912-679-8000
  • Fax:
Mailing address:
  • Phone: 912-679-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN191658
License Number StateGA

VIII. Authorized Official

Name: MRS. JUDY MARSHALL
Title or Position: MANAGER, PHYSICIAN PRACTICES
Credential:
Phone: 912-466-5520