Provider Demographics
NPI:1861678815
Name:ADVANCED NP SERVICES
Entity Type:Organization
Organization Name:ADVANCED NP SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, NP-C
Authorized Official - Phone:678-289-6618
Mailing Address - Street 1:242 SUMMERFORD PL
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-2892
Mailing Address - Country:US
Mailing Address - Phone:678-289-6618
Mailing Address - Fax:678-289-4274
Practice Address - Street 1:242 SUMMERFORD PL
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-2892
Practice Address - Country:US
Practice Address - Phone:678-289-6618
Practice Address - Fax:678-289-4274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN084801NP163WR0006X, 363L00000X, 363LF0000X
GARN084801163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty
No163WS0121XNursing Service ProvidersRegistered NursePlastic SurgeryGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I500088OtherMEDICARE PROVIDER NUMBER
GA511I500088OtherMEDICARE PROVIDER NUMBER