=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386607588
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH H COOPER PA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2006
-----------------------------------------------------
Last Update Date | 04/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1220 TROTWOOD AVE SUITE 401
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38401-6433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-388-6550
-----------------------------------------------------
Fax | 931-388-6549
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 854 W JAMES CAMPBELL BLVD SUITE 303-A
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38401-4659
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-540-4255
-----------------------------------------------------
Fax | 931-490-4654
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 831
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------