Individual
SANDY TYRONE COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2829 E HIGHWAY 76, MULLINS, SC 29574-6035
(843) 431-2000
Mailing address
PO BOX 603898, CHARLOTTE, NC 28260-3898
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
15626
SC
207Q00000X
Family Medicine Physician
15626
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
L12724
—
SC
Enumeration date
03/09/2006
Last updated
03/24/2021
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