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General NPI Number Information
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NPI Number | 1225079452
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Entity Type | Individual
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Provider Name | MICHAEL TOWNSEND COOPER JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3208 SHRINE RD
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City | BRUNSWICK
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State | GA
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Zip | 31520-4325
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Country | US
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Telephone | 912-265-2036
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Fax | 912-265-6779
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Provider Business Mailing Address
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Address Line | 3208 SHRINE RD
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City | BRUNSWICK
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State | GA
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Zip | 31520-4325
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Country | US
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Telephone | 912-265-2036
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Fax | 912-265-6779
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 054478
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License Number State | GA
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