Provider Demographics
NPI:1407418098
Name:COOPER, ELIZABETH LEIGH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LEIGH
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 GREENMONT CIR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-3497
Mailing Address - Country:US
Mailing Address - Phone:770-355-2875
Mailing Address - Fax:
Practice Address - Street 1:3850 WINDERMERE PKWY STE 105
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7033
Practice Address - Country:US
Practice Address - Phone:678-455-2800
Practice Address - Fax:770-888-9998
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN231470163WE0003X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency