Individual
COREY WAYNE COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
96 JONATHAN LUCAS ST, CHARLESTON, SC 29425-8900
(843) 792-1414
Mailing address
4357 WEED SPARKSVILLE RD, COLUMBIA, KY 42728-8135
Taxonomy
Speciality
Code
Description
License number
State
246QM0706X
Medical Technologist
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/13/2023
Last updated
11/13/2023
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