Doctor Name: | ROBERT CHARLTON COOPER |
NPI Number: | 1285814830 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | OTR/L |
License Number: | OT004016 |
Business Practice Address: | 7950 Martin Loop Bldg 9200 Fort Benning, GA - 319055647 |
Business Phone Number: | 7065441442 |
Business Fax Number: | |
Mailing Address: | 10420 Whitesville Rd, FORTSON |
State: | GA |
Postal Code: | 318082621 |
Phone Number: | 7063232641 |
Fax Number: | |
NPI Enumeration Date: | 11/13/2007 |
NPI Last Update Date: | 11/13/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 171000000X |
License Number: | OT004016 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Military Health Care Provider |
Taxonomy Specialization: | |
Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |