Provider Demographics
NPI:1871508606
Name:NOVA FAMILY CARE
Entity Type:Organization
Organization Name:NOVA FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-776-9143
Mailing Address - Street 1:PO BOX 465
Mailing Address - Street 2:
Mailing Address - City:SYLVESTER
Mailing Address - State:GA
Mailing Address - Zip Code:31791-0465
Mailing Address - Country:US
Mailing Address - Phone:229-776-9143
Mailing Address - Fax:
Practice Address - Street 1:807 S ISABELLA ST
Practice Address - Street 2:SUITE C
Practice Address - City:SYLVESTER
Practice Address - State:GA
Practice Address - Zip Code:31791-7554
Practice Address - Country:US
Practice Address - Phone:229-776-9143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GABC4653247207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADD6608OtherRAILROAD MEDICARE
GA000689279EMedicaid
GADD6608OtherRAILROAD MEDICARE
GAG21585Medicare UPIN