Provider Demographics
NPI:1922212323
Name:COOPER PSYCHOLOGICAL SERVICES PC
Entity Type:Organization
Organization Name:COOPER PSYCHOLOGICAL SERVICES PC
Other - Org Name:JOHN T COOPER PHD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-435-7770
Mailing Address - Street 1:227 SANDY SPRINGS PLACE
Mailing Address - Street 2:#D375
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5918
Mailing Address - Country:US
Mailing Address - Phone:770-435-7770
Mailing Address - Fax:770-435-9440
Practice Address - Street 1:3188 ATLANDTA RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080
Practice Address - Country:US
Practice Address - Phone:770-435-7770
Practice Address - Fax:770-435-9440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1460103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00441548DMedicaid
GA00441548DMedicaid