Individual
GREGORY J COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
102 E RAVINE RD, KINGSPORT, TN 37660-3814
(423) 245-9600
Mailing address
PO BOX 699, MOUNTAIN HOME, TN 37684-0699
(423) 245-9600
(423) 224-5963
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD61883
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q042523
—
TN
Enumeration date
04/27/2017
Last updated
02/01/2024
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