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General NPI Number Information
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NPI Number | 1659709152
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Entity Type | Organization
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Legal Business Name | COOPERATIVE HEALTHCARE SERVICES INC
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Dates
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Enumeration Date | 10/17/2013
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Last Update Date | 10/17/2013
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Provider Practice Location Address
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Address Line | 2040 DAN PROCTOR DR SUITE 140
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City | SAINT MARYS
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State | GA
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Zip | 31558-3811
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Country | US
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Telephone | 912-679-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 2040 DAN PROCTOR DR SUITE 140
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City | SAINT MARYS
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State | GA
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Zip | 31558-3811
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Country | US
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Telephone | 912-679-8000
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Fax |
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Authorized Official
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Title or Position | MANAGER, PHYSICIAN PRACTICES
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Name | MRS. JUDY MARSHALL
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Credential |
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Telephone | 912-466-5520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN191658
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License Number State | GA
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