Provider Demographics
NPI:1508934191
Name:COOPER, OZITA DAREACE (MD)
Entity type:Individual
Prefix:
First Name:OZITA
Middle Name:DAREACE
Last Name:COOPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 MARKETPLACE BLVD # 130332
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-5747
Mailing Address - Country:US
Mailing Address - Phone:833-633-3632
Mailing Address - Fax:
Practice Address - Street 1:3645 MARKETPLACE BLVD
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-5747
Practice Address - Country:US
Practice Address - Phone:833-633-3632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3073712083B0002X
KY502932083B0002X
WAMD611192902083B0002X
VA01010545252083B0002X
RIMD173892083B0002X
MO104917207P00000X
GA444342083B0002X
MN26612083B0002X
WI757682083B0002X
UT11970900-12052083B0002X
FLME1279072083B0002X
MT915752083B0002X
GA044434207P00000X
CODR.00654782083B0002X
MI43015035582083B0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine