Individual
DR. MARTHA LOUISE COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
807 S ISABELLA ST, SYLVESTER, GA 31791-7554
(229) 776-9143
Mailing address
807 S ISABELLA ST, SYLVESTER, GA 31791-7554
(229) 776-9143
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
BC4653247
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000689279E
—
GA
01
—
52623456004
BCBS OF GEORGIA
GA
01
—
P00242174
RAILROAD MEDICARE
GA
Enumeration date
05/16/2007
Last updated
10/21/2008
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