Provider Demographics
NPI:1205843588
Name:COOPER, SCOTT D (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:D
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:320 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2432
Mailing Address - Country:US
Mailing Address - Phone:770-479-5535
Mailing Address - Fax:770-479-8821
Practice Address - Street 1:1400 NORTHSIDE FORSYTH DR STE 250
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7701
Practice Address - Country:US
Practice Address - Phone:770-889-7118
Practice Address - Fax:770-844-7835
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0276962084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
13BDCNPMedicare ID - Type Unspecified
C74424Medicare UPIN