Individual
LAWRENCE ANDREW COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SOLE PROPRIETOR
Contact information
Practice address
220 REEDY RIVER CT, ROEBUCK, SC 29376-3371
(864) 641-9200
Mailing address
220 REEDY RIVER CT, ROEBUCK, SC 29376-3371
(864) 641-9200
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
EA6001
—
SC
05
—
EA6002
—
SC
Enumeration date
05/08/2020
Last updated
05/08/2020
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