Provider Demographics
NPI:1659970960
Name:COOPER, LYNDSEY (RD)
Entity Type:Individual
Prefix:
First Name:LYNDSEY
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 BRYAN CIR
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-8206
Mailing Address - Country:US
Mailing Address - Phone:443-944-6251
Mailing Address - Fax:
Practice Address - Street 1:942 BRYAN CIR
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-8206
Practice Address - Country:US
Practice Address - Phone:443-944-6251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered