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:
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Health care specialties

SpecialtyCodeLicense #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 4 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1083612352 NPPES
South Carolina MEDICAID G22737
South Carolina MEDICAID 000221625A

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