Organization
NOVA FAMILY CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARTHA LOUISE COOPER M.D. (OWNER)
(229) 776-9143
Entity
Organization
Contact information
Practice address
807 S ISABELLA ST, SUITE C, SYLVESTER, GA 31791-7554
(229) 776-9143
Mailing address
PO BOX 465, SYLVESTER, GA 31791-0465
(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
—
DD6608
RAILROAD MEDICARE
GA
Enumeration date
07/30/2006
Last updated
04/18/2008
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