Provider Demographics
NPI:1194733543
Name:COOLEY, CHRISTOPHER L (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:L
Last Name:COOLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-271-2020
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:7148 U S HIGHWAY 98
Practice Address - Street 2:SUITE 201
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8577
Practice Address - Country:US
Practice Address - Phone:601-271-2020
Practice Address - Fax:601-264-2660
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18413207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1582221Medicaid
MS640507572ZUOtherAMERICAN ADMIN GROUP
MS04103763Medicaid
MS640507572ZUOtherAMERICAN ADMIN GROUP
MS180000341Medicare PIN
LA1582221Medicaid