Provider Demographics
NPI:1497075709
Name:COOPER, AVA BIANCA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:AVA
Middle Name:BIANCA
Last Name:COOPER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 CUMBERLAND PKWY SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3915
Mailing Address - Country:US
Mailing Address - Phone:770-431-4235
Mailing Address - Fax:770-431-4371
Practice Address - Street 1:2525 CUMBERLAND PKWY SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3915
Practice Address - Country:US
Practice Address - Phone:770-431-4235
Practice Address - Fax:770-431-4371
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant