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General NPI Number Information
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NPI Number | 1679923064
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Entity Type | Individual
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Provider Name | KEEVIS COOPER
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Gender | Male
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Dates
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Enumeration Date | 06/16/2016
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Last Update Date | 12/19/2022
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Provider Practice Location Address
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Address Line | 3740 CASCADE RD SW
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City | ATLANTA
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State | GA
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Zip | 30331-2108
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Country | US
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Telephone | 404-472-1949
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Fax |
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Provider Business Mailing Address
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Address Line | 3740 CASCADE RD SW
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City | ATLANTA
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State | GA
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Zip | 30331-2108
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Country | US
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Telephone |
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Fax |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 027957
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License Number State | GA
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