MEDICARE: C. COOPER ENTERPRISES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	332BC3200X	Customized Equipment (DME)
2	332BD1200X	Dialysis Equipment & Supplies (DME)
3	332BN1400X	Nursing Facility Supplies (DME)
4	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
5	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1306424908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C. COOPER ENTERPRISES LLC

Provider Business Mailing Address
First Line	:	290 MARTIN LUTHER KING JR DR SE UNIT 1012
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-2525
Country	:	US
Telephone Number	:	833-878-3567
Fax Number	:

Provider Business Practice Location Address
First Line	:	290 MARTIN LUTHER KING JR DR SE UNIT 1012
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-2525
Country	:	US
Telephone Number	:	833-878-3567
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	COREY COOPER
Credential	:
Telephone Number	:	833-878-3567

Provider Enumeration Date	:	04/02/2021
Last Update Date	:	04/02/2021

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Directions to “C. COOPER ENTERPRISES LLC ” Practice Location

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