Provider Demographics
NPI:1275544652
Name:COOPER, JUDY LYNN (R ,MR)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:LYNN
Last Name:COOPER
Suffix:
Gender:F
Credentials:R ,MR
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:321 WESLEYAN DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4110
Mailing Address - Country:US
Mailing Address - Phone:478-476-9820
Mailing Address - Fax:
Practice Address - Street 1:1504 HARDEMAN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1416
Practice Address - Country:US
Practice Address - Phone:478-745-3135
Practice Address - Fax:478-745-3136
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
104315247100000X, 2471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Not Answered2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging