Individual
MRS. MARY LANE COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA/C
Contact information
Practice address
3609 BILL HODGES RD, CLAXTON, GA 30417-6235
(912) 739-4807
(912) 739-2939
Mailing address
3609 BILL HODGES RD, CLAXTON, GA 30417-6235
(912) 739-4807
(912) 739-2939
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1586
GA
Other
Enumeration date
09/14/2012
Last updated
09/14/2012
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