Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RN300745 | GA |
NPI | 1346832052 |
---|---|
Provider Name | Austin Taylor Cooper |
First Address | Ooltewah, TN 37363-9024 |
Second Address | Dalton, GA 30720-2529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2021 |
Last Update Date | 23/03/2021 |