Individual
CONDACE DORNELLA COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.D.
Contact information
Practice address
903 N COURT ST, QUITMAN, GA 31643-1315
(229) 263-4171
Mailing address
920 CAIRO RD, THOMASVILLE, GA 31792-4255
(229) 228-8800
(229) 228-8892
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD003261
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
925267
REGISTERED DIETITIAN
GA
01
—
LD003261
LICENSE
GA
Enumeration date
04/01/2009
Last updated
04/01/2009
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