Healthcare Provider Details

I. General information

NPI: 1487001798
Provider Name (Legal Business Name): TERRILL ANTHONY COOPER NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 MARGIE DR STE F
WARNER ROBINS GA
31088-8908
US

IV. Provider business mailing address

335 MARGIE DR STE F
WARNER ROBINS GA
31088-8908
US

V. Phone/Fax

Practice location:
  • Phone: 478-227-4051
  • Fax:
Mailing address:
  • Phone: 478-227-4051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN202887
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN202887
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN202887
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: