Provider Demographics
NPI:1427686047
Name:REDDING, ALLIE COOPER (DO)
Entity type:Individual
Prefix:MRS
First Name:ALLIE
Middle Name:COOPER
Last Name:REDDING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:ALLIE
Other - Middle Name:MARINA
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 630
Mailing Address - Street 2:
Mailing Address - City:PROSPERITY
Mailing Address - State:SC
Mailing Address - Zip Code:29127-0630
Mailing Address - Country:US
Mailing Address - Phone:803-364-4852
Mailing Address - Fax:
Practice Address - Street 1:600 N WHEELER AVE
Practice Address - Street 2:
Practice Address - City:PROSPERITY
Practice Address - State:SC
Practice Address - Zip Code:29127-9332
Practice Address - Country:US
Practice Address - Phone:803-364-4852
Practice Address - Fax:803-364-2014
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC83218208D00000X, 207Q00000X
SC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program