Healthcare Provider Details

I. General information

NPI: 1841723251
Provider Name (Legal Business Name): AMANDA JULIA COOLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 07/27/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 SIMPSON HIGHWAY 49
MAGEE MS
39111
US

IV. Provider business mailing address

360 SIMPSON HIGHWAY 149
MAGEE MS
39111-3841
US

V. Phone/Fax

Practice location:
  • Phone: 601-439-0635
  • Fax:
Mailing address:
  • Phone: 601-439-0635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number26877
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: