Individual
COOPER BOONE UTLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
250 W GREEN ST, ATHENS, GA 30602-5036
(706) 542-1911
Mailing address
840 ZION HOPE RD, TIFTON, GA 31793-5407
(229) 326-7797
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
PHI-023067
GA
Other
Enumeration date
06/02/2026
Last updated
06/02/2026
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