Provider Demographics
NPI:1942052816
Name:SJ COOPER, LLC
Entity Type:Organization
Organization Name:SJ COOPER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAUNTAE
Authorized Official - Middle Name:T
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MASTER COSMETOLOGIST
Authorized Official - Phone:912-233-7445
Mailing Address - Street 1:801 W 40TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31415-8707
Mailing Address - Country:US
Mailing Address - Phone:912-604-1172
Mailing Address - Fax:
Practice Address - Street 1:218 W VICTORY DR STE 9
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-1718
Practice Address - Country:US
Practice Address - Phone:912-231-7445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment