Individual
ANGELA HUCKS COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
618 N MAIN ST, MARION, SC 29571-3034
(843) 433-8010
(843) 433-8692
Mailing address
PO BOX 1440, MARION, SC 29571-1440
(843) 433-8010
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
888
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0209PA
—
SC
01
—
7153
MEDICARE GROUP NUMBER
SC
01
—
GP4377
MEDICAID GROUP NUMBER
SC
Enumeration date
06/23/2006
Last updated
01/16/2023
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