Individual
NICOLE COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4825 JASMINE WAY, HEPHZIBAH, GA 30815-5874
(706) 836-0979
Mailing address
2059 CLARK ST, AUGUSTA, GA 30904-3067
(706) 738-2996
Taxonomy
Speciality
Code
Description
License number
State
376G00000X
Nursing Home Administrator
Primary
—
—
Other
Enumeration date
08/14/2021
Last updated
08/14/2021
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