Individual
TAMMY HYATT COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
719 N MAIN ST, MARION, SC 29571-2517
(843) 423-1811
(843) 431-5425
Mailing address
3035 BURKE RD, DILLON, SC 29536-7513
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
30412
SC
Other
Enumeration date
10/02/2015
Last updated
10/02/2015
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