Provider Demographics
NPI:1386607588
Name:COOPER, JOSEPH H (PA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:H
Last Name:COOPER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 W JAMES CAMPBELL BLVD
Mailing Address - Street 2:SUITE 303-A
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4659
Mailing Address - Country:US
Mailing Address - Phone:931-540-4255
Mailing Address - Fax:931-490-4654
Practice Address - Street 1:1220 TROTWOOD AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-6433
Practice Address - Country:US
Practice Address - Phone:931-388-6550
Practice Address - Fax:931-388-6549
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI831363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3723206Medicaid
TN4163956OtherBCBST
TN3665104Medicaid
WI42955100Medicaid
WI42955100Medicaid
TN3665104Medicare PIN
TNDB4643Medicare PIN
TN3723206Medicaid