Provider Demographics
NPI:1912165283
Name:COOPER, ADRIENNE J (MED)
Entity Type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:J
Last Name:COOPER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:235 CHERRY BARK WAY UNIT 23
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-1956
Mailing Address - Country:US
Mailing Address - Phone:706-226-4623
Mailing Address - Fax:706-278-0580
Practice Address - Street 1:1011 PROFESSIONAL BLVD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2506
Practice Address - Country:US
Practice Address - Phone:706-226-4623
Practice Address - Fax:706-278-0580
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006856235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist