Provider Demographics
NPI:1295999050
Name:COOLEY, NAN W (PSYD)
Entity type:Individual
Prefix:
First Name:NAN
Middle Name:W
Last Name:COOLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2085 S MILLEDGE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-1655
Mailing Address - Country:US
Mailing Address - Phone:706-369-6363
Mailing Address - Fax:706-369-6239
Practice Address - Street 1:2085 S MILLEDGE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-1655
Practice Address - Country:US
Practice Address - Phone:706-369-6363
Practice Address - Fax:706-369-6239
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003425103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical