Individual
MELISSA SHUNTA COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CMA
Contact information
Practice address
4600 FARMINGTON RD, WATKINSVILLE, GA 30677-4374
(706) 340-9566
Mailing address
4600 FARMINGTON RD, WATKINSVILLE, GA 30677-4374
(706) 340-9566
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
Primary
20268794737
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
87-1622293
ELITE MOBILE PHLEBOTOMIST OF GA. LLC
GA
Enumeration date
10/11/2021
Last updated
10/11/2021
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