Individual
LATOYA SOPHIA COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
300 MAGNOLIA BLVD APT 102, PORT WENTWORTH, GA 31407-3448
(912) 429-4844
Mailing address
300 MAGNOLIA BLVD APT 102, PORT WENTWORTH, GA 31407-3448
(912) 429-4844
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
1100149310
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2600
—
GA
Enumeration date
05/15/2017
Last updated
02/11/2021
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