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General NPI Number Information
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NPI Number | 1700519147
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Entity Type | Individual
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Provider Name | GABRIELLE MICHELE COOPER CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 07/04/2022
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Last Update Date | 07/04/2022
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Provider Practice Location Address
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Address Line | 2366 BATTLEFIELD PKWY
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City | FORT OGLETHORPE
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State | GA
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Zip | 30742-4030
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Country | US
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Telephone | 706-452-5830
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Fax |
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Provider Business Mailing Address
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Address Line | 4218 GREEN SHANTY RD
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City | OOLTEWAH
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State | TN
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Zip | 37363-9024
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Country | US
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Telephone | 423-322-5928
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | GAA-NP000795
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License Number State | GA
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