Provider Demographics
NPI:1639951668
Name:COOPER, CARMEN (MA)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 N HAIRSTON RD STE 4
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-2850
Mailing Address - Country:US
Mailing Address - Phone:404-500-0087
Mailing Address - Fax:
Practice Address - Street 1:933 N HAIRSTON RD STE 4
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-2850
Practice Address - Country:US
Practice Address - Phone:404-500-0087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAS5J3S5Q8374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician