Provider Demographics
NPI:1629073978
Name:COOPER, BRENDA GAIL (MD)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:GAIL
Last Name:COOPER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6501 PEAKE RD
Mailing Address - Street 2:STE 900
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-8051
Mailing Address - Country:US
Mailing Address - Phone:478-471-9047
Mailing Address - Fax:478-757-1088
Practice Address - Street 1:6501 PEAKE RD
Practice Address - Street 2:STE 900
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-8051
Practice Address - Country:US
Practice Address - Phone:478-471-9047
Practice Address - Fax:478-757-1088
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2010-08-16
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Provider Licenses
StateLicense IDTaxonomies
GA038453207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology