Individual
JERRY DEWAYNE COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
013262
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00134142G
—
GA
Enumeration date
11/22/2005
Last updated
03/26/2013
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