Cooper, Randy Wilson
Cooper, Randy Wilson is an individual health care provider with primary practice located at 818 Saint Sebastian Way Ste 104 , Augusta GA 30901-2652. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Cooper, Randy Wilson can be contacted via phone (706) 434-0130.Contact Information
Primary practice address
818 Saint Sebastian Way Ste 104
Augusta GA 30901-2652
Phone: (706) 434-0130
Fax: (706) 434-0131
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Allopathic & Osteopathic Physicians / Surgery | 208600000X | 022737 | Georgia |
Profile Details
NPI number | 1083612352 |
---|---|
LBN Legal business name | Cooper, Randy Wilson |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Jul 12th, 2005 |
Last updated | Mar 23rd, 2022 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1083612352 | NPPES |
South Carolina | MEDICAID | G22737 | |
South Carolina | MEDICAID | 000221625A |
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