Individual
DR. RANDY WILSON COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
818 SAINT SEBASTIAN WAY STE 104, AUGUSTA, GA 30901-2652
(706) 434-0130
(706) 434-0131
Mailing address
PO BOX 1705, AUGUSTA, GA 30903-1705
(706) 854-6008
(706) 854-6946
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
022737
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000221625A
—
GA
05
—
G22737
—
SC
Enumeration date
07/12/2005
Last updated
03/23/2022
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