Provider Demographics
NPI:1730534546
Name:COOPER, AARON HUMPHREY
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:HUMPHREY
Last Name:COOPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2448 DRESDEN PARC CIR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-1673
Mailing Address - Country:US
Mailing Address - Phone:404-735-1568
Mailing Address - Fax:
Practice Address - Street 1:720 WESTVIEW DR, SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310
Practice Address - Country:US
Practice Address - Phone:404-756-1217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-29
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program