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General NPI Number Information
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NPI Number | 1447917604
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Entity Type | Individual
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Provider Name | AMY COOPER OUTLAW PHARMD
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Gender | Female
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Dates
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Enumeration Date | 11/23/2021
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Last Update Date | 11/23/2021
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Provider Practice Location Address
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Address Line | 1 TECHNOLOGY PKWY S
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City | NORCROSS
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State | GA
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Zip | 30092-2928
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Country | US
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Telephone | 762-289-0300
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Fax | 855-748-0572
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Provider Business Mailing Address
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Address Line | 1 TECHNOLOGY PKWY S
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City | NORCROSS
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State | GA
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Zip | 30092-2928
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Country | US
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Telephone | 762-289-0300
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Fax | 855-748-0572
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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 | 1835P1300X
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Taxonomy Name | Psychiatric Pharmacist
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License Number | GA016616
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License Number State | GA
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