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NPI Code Detail

MEDICARE: COOPER MARK BLEVINS

MEDICARE: COOPER MARK BLEVINS
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
12355S0801XSpeech-Language Assistant01038NC

General Provider Information

NPI Number : 1427974351
Entity Type Code : Individual
Provider Name (Legal Business Name) : COOPER MARK BLEVINS
Provider Business Mailing Address
First Line : 2500 N CHURCH ST
Second Line :
City : GREENSBORO
State : NC
Zip : 27405-4314
Country : US
Telephone Number : 336-375-2240
Fax Number :
Provider Business Practice Location Address
First Line : 2500 N CHURCH ST
Second Line :
City : GREENSBORO
State : NC
Zip : 27405-4314
Country : US
Telephone Number : 336-375-2240
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2026
Last Update Date : 06/25/2026

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Directions to “ COOPER MARK BLEVINS ” Practice Location

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