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General NPI Number Information
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NPI Number | 1841723251
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Entity Type | Individual
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Provider Name | AMANDA JULIA COOLEY MD
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Gender | Female
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Dates
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Enumeration Date | 04/04/2017
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Last Update Date | 07/27/2021
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Provider Practice Location Address
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Address Line | 360 SIMPSON HIGHWAY 49
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City | MAGEE
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State | MS
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Zip | 39111
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Country | US
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Telephone | 601-439-0635
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Fax |
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Provider Business Mailing Address
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Address Line | 360 SIMPSON HIGHWAY 149
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City | MAGEE
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State | MS
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Zip | 39111-3841
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Country | US
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Telephone | 601-439-0635
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 26877
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License Number State | MS
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