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General NPI Number Information
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NPI Number | 1700167426
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Entity Type | Individual
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Provider Name | EVA COOPER
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Gender | Female
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Dates
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Enumeration Date | 09/08/2011
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Last Update Date | 07/26/2021
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Provider Practice Location Address
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Address Line | 1024 US HIGHWAY 80 W STE 206
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City | POOLER
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State | GA
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Zip | 31322-2188
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Country | US
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Telephone | 912-342-3036
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Fax |
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Provider Business Mailing Address
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Address Line | 40 PENNINGTON DR UNIT D
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City | BLUFFTON
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State | SC
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Zip | 29910-6053
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Country | US
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Telephone | 843-227-1410
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 90240
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License Number State | SC
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