Provider Demographics
NPI:1265392880
Name:COOPER, GERALDINE
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 BROOKSIDE AVE UNIT 313
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2690
Mailing Address - Country:US
Mailing Address - Phone:770-597-9815
Mailing Address - Fax:
Practice Address - Street 1:301 BROOKSIDE AVE UNIT 313
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2690
Practice Address - Country:US
Practice Address - Phone:770-597-9815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-15
Last Update Date:2025-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA342000000X, 343800000X, 343900000X, 347C00000X, 385H00000X, 171W00000X, 177F00000X, 174200000X, 253Z00000X, 332U00000X, 335G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No342000000XTransportation ServicesTransportation Network Company
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care
No177F00000XOther Service ProvidersLodging
No174200000XOther Service ProvidersMeals
No253Z00000XAgenciesIn Home Supportive Care
No332U00000XSuppliersHome Delivered Meals
No335G00000XSuppliersMedical Foods Supplier