Healthcare Provider Details

I. General information

NPI: 1942052816
Provider Name (Legal Business Name): SJ COOPER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 W VICTORY DR STE 9
SAVANNAH GA
31405-1718
US

IV. Provider business mailing address

801 W 40TH ST
SAVANNAH GA
31415-8707
US

V. Phone/Fax

Practice location:
  • Phone: 912-231-7445
  • Fax:
Mailing address:
  • Phone: 912-604-1172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHAUNTAE T COOPER
Title or Position: SPECIALIST
Credential: MASTER COSMETOLOGIST
Phone: 912-233-7445