Healthcare Provider Details

I. General information

NPI: 1356888309
Provider Name (Legal Business Name): SAVANNAH COOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 01/31/2024
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 W FRANKLIN ST
SYLVESTER GA
31791-7174
US

IV. Provider business mailing address

PO BOX 846
SYLVESTER GA
31791-0846
US

V. Phone/Fax

Practice location:
  • Phone: 229-821-3892
  • Fax: 229-821-3893
Mailing address:
  • Phone: 229-821-3892
  • Fax: 229-821-3893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT012764
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: